Failure to Follow Professional Standards for PICC Line Care and IV Administration
Penalty
Summary
A deficiency was identified when a resident with a peripherally inserted central catheter (PICC) line for daily intravenous (IV) antibiotic administration was observed to have a dressing that included a folded white gauze under a transparent covering, dated several days prior. The resident confirmed that the dressing was being changed weekly, despite receiving daily IV antibiotics. Review of the Treatment Administration Record and Medication Administration Record indicated the last dressing change occurred several days before the observation. Facility policy required site care every 72 hours and as necessary, and the Director of Nursing confirmed that a gauze dressing should be changed within 48 hours. Additionally, the presence of gauze under the transparent dressing prevented direct assessment of the insertion site for signs of infection. During an observed IV medication administration, a registered nurse donned gloves, cleaned and flushed the PICC line, and began to connect the IV tubing. Multiple air bubbles were observed in the tubing, which the nurse noticed and then replaced the tubing before completing the administration. The Director of Nursing acknowledged that air bubbles should be drained prior to connecting IV tubing. These actions demonstrated a failure to follow professional standards of practice for PICC line care and IV medication administration, as required by facility policy and regulatory standards.
Plan Of Correction
Element 1 R42 no longer resides at the facility. Element 2 The residents that reside in the facility have the potential to be affected. An audit was completed on the residents residing in the facility that have PICC lines to ensure when a gauze dressing is used it is to be changed to no longer than 48 hours; and when priming IV lines that contain excessive air bubbles must be consistent with professional standards of practice. Any areas of deficiency at the time of the audit will be corrected immediately. Element 3 The IV Therapy policy was reviewed by the DON and ADON/IC and updated to our pharmacy's "Catheter Insertion and Care" policy and deemed appropriate. The nurses were reeducated on the Pharmacy's policy to ensure when gauze dressings are used, they are to be changed no longer than 48 hours, and when priming IV lines that contain excessive air bubbles must be consistent with professional standards of practice, i.e., fluid must run through the line into a waste receptacle until air is gone or acquire new IV tubing. Element 4 The DON and/or designee will conduct random audits twice a week for 2 months, to ensure nurses are following the "Catheter Insertion and Care". Any areas of deficiency at the time of the audits will be corrected immediately, and the results of these audits will be presented at the facility's QAPI for further review and/or corrective action. Element 5 Date of compliance 06/27/25. The Administrator and/or designee will be responsible for sustained compliance.