Failure to Validate Nursing Staff Competency for Specialized Resident Care
Penalty
Summary
Nursing staff at the facility failed to demonstrate and document appropriate competencies for specialized care required by several residents. Specifically, three licensed vocational nurses (LVN 2, LVN 3, and TN 2) did not have documented competency in providing care for a resident undergoing dialysis, including assessment of the arterio-venous fistula site for bruit and thrill before and after dialysis treatments. The Director of Nursing (DON) and Director of Staff Development (DSD) confirmed that the competency forms for these nurses did not include dialysis care, and the required assessments were not performed as indicated in the residents' records. Additionally, the same three nurses lacked documented competency in the care and replacement of suprapubic catheters for another resident who returned from the hospital with this device. Although the nurses indicated prior experience or education in suprapubic catheter care, there was no evidence of return demonstration or validation of their skills by the facility. The DSD was unable to provide documentation of competencies in all areas related to suprapubic catheter care, assessment, and replacement for these nurses. Furthermore, two registered nurses (RN 1 and RN 3) did not have documented competencies for the care and management of midline catheters and peripherally inserted central catheters (PICC) for several residents receiving intravenous antibiotics. The competency forms reviewed did not include specific skills related to midline or PICC line care, and the DSD could not provide evidence of validated skills or knowledge for these procedures. The facility's policy required that nurses be competent in skills related to their assigned duties, with competencies validated prior to independent performance and annually thereafter, but this was not followed for the specialized care in question.