Failure to Provide Proper Midline Catheter Care and Manage Hypotension
Penalty
Summary
A deficiency occurred when the facility failed to provide appropriate care for a resident with a Peripherally Inserted Midline Catheter. The resident had orders for the Midline dressing to be changed every seven days on the night shift for IV therapy. Observations revealed that the dressing was not labeled or dated, and the resident reported the dressing had not been changed as scheduled. Staff interviews confirmed that Licensed Practical Nurses (LPNs) were not responsible for changing Midline dressings, and the Registered Nurse (RN) acknowledged the dressing should have been changed and labeled. Documentation on the Medication Administration Record (MAR) was inaccurate, as an LPN had signed for a dressing change that did not occur. The facility's policy required dressings to be changed at specific intervals and properly documented, which was not followed in this case. Another deficiency was identified in the management of a resident's low blood pressure. The resident, who had multiple medical diagnoses and moderate cognitive impairment, reported feeling weak and tired after her blood pressure was found to be low by an LPN. Despite repeated low readings, the LPN did not promptly recheck the blood pressure or notify the physician as required. The resident expressed concern about her condition, and subsequent readings continued to show hypotension. The Director of Nursing confirmed that the LPN should have monitored the blood pressure more frequently and notified the physician when the medication did not improve the resident's condition, as per facility policy. Both deficiencies were supported by direct observations, staff and resident interviews, and record reviews. The facility failed to follow its own policies and physician orders regarding catheter care and the management of significant changes in a resident's condition, resulting in lapses in care for two residents.