Deficient IV Fluid Administration and Documentation
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of intravenous (IV) fluids in accordance with professional standards of practice for two out of three residents reviewed for hydration. In one instance, a resident with severe cognitive impairment and a dislodged gastrostomy tube was observed receiving IV fluids from a bag that was past its expiration date. The LPN who administered the IV fluids admitted to not checking the expiration date before use, and the Unit Manager was unaware that expired fluids were being administered. The DON confirmed that nurses are required to verify both the match to the physician's order and the expiration date of IV solutions before administration. In another case, a resident with intact cognition and a need for IV hydration due to diarrhea was found with an undated peripheral IV catheter dressing. The physician's order for IV hydration lacked critical details, including the infusion rate and instructions for assessment and maintenance of the IV site. There was also no documented order for the insertion of the IV line or for dressing changes. The Medication Administration Record did not specify the infusion rate, and the Treatment Administration Record lacked documentation of site inspection, assessment, or dressing changes as required by facility policy. Interviews with nursing staff and the DON revealed lapses in following established protocols, such as failing to date IV dressings and not ensuring complete and accurate physician orders for IV therapy. The attending physician and medical director both acknowledged that the orders were incomplete and not properly reviewed or signed. These deficiencies were observed during the recertification survey and were not accompanied by any corrective or follow-up actions in the report.