Failure to Provide Safe and Appropriate IV Therapy Administration and Maintenance
Penalty
Summary
The facility failed to provide care and maintenance of intravenous (IV) therapy consistent with professional standards of practice for two residents. For one resident admitted with a non-valved, double lumen peripherally inserted central catheter (PICC) line, nursing staff did not correctly transcribe and administer physician orders for flushing the PICC line. The resident's medical record and medication administration record (MAR) showed no evidence that required saline and heparin flushes had been administered since admission, despite clear physician orders and facility protocols mandating regular flushing to maintain catheter patency. Observations and interviews confirmed that the MAR was not set up correctly, and staff were unaware of the need to flush the PICC line as ordered, resulting in the line not being flushed until the surveyor's intervention. For another resident with a peripheral intravenous catheter (PIV) placed for antibiotic administration, the facility did not obtain or follow orders for essential aspects of PIV care, including flushing, site rotation, dressing changes, and monitoring for infection or infiltration. The resident's PIV remained in place beyond the recommended 72-hour period, and the dressing was observed to be partially lifted and frayed. Nursing notes and interviews revealed that batch orders for PIV care, which were available in the electronic charting system, were not obtained or implemented. The PIV was only discontinued after the surveyor's observation and subsequent notification of the nurse practitioner. Both deficiencies were confirmed through review of facility policies, resident records, direct observation, and staff interviews. The failures included not following established protocols for IV care, not ensuring accurate transcription of physician orders into the MAR, and not performing required documentation and monitoring. These lapses resulted in residents not receiving appropriate IV care as ordered and as required by professional standards.