Failure to Ensure RN Competency in IV Administration and Aseptic Technique
Penalty
Summary
A registered nurse (RN) failed to demonstrate proper competency in administering intravenous (IV) antibiotics through a midline/peripheral catheter for a resident. During an observed medication administration, the RN did not scrub the midline catheter infusion port with an antiseptic solution before flushing with normal saline or before attaching a new IV antibiotic line. The RN also allowed the port to rest on the resident's bare skin during the process. The RN acknowledged that the port should have been scrubbed prior to these steps to prevent infection. Further review of the resident's medical records and care plan confirmed that there were physician orders to flush the midline catheter with normal saline before and after medication administration and to change the peripheral IV line and dressing every 48 hours. However, the midline catheter dressing was not changed as ordered, with the dressing observed to be overdue for replacement. Another nurse confirmed that the failure to change the dressing as scheduled increased the risk of infection for the resident. The Director of Staff Development (DSD) and Director of Nursing (DON) both stated that the RN should have completed a competency check on IV administration within 90 days of employment, but no such documentation was found in the RN's file. Facility policies and procedures required strict aseptic technique, including scrubbing all injection ports with an antiseptic for a specified duration, and mandated timely dressing changes, but these protocols were not followed in this instance.