Failure to Document IV Flushes and Obtain Orders for Catheter Care
Penalty
Summary
The facility failed to ensure that intravenous (IV) catheters were flushed according to facility policy and did not obtain physician's orders for the care and maintenance of IV catheters for two residents. Facility policy required that midline dressings be changed weekly or as needed, and that IV lines be flushed according to physician orders. The policy for peripheral IV access specified a regimen of Normal Saline flush before and after medication administration, and a Heparin flush if ordered. For one resident, clinical records showed that the resident was cognitively intact, had a multi-drug resistant organism, was receiving IV antibiotics, and had IV access. Physician's orders included administration of Meropenem and routine saline flushes every shift. However, review of the Medication Administration Records (MARs) revealed no documented evidence that staff flushed the resident's IV with Normal Saline before and after medication administration, as required by policy and physician orders. The Director of Nursing confirmed the lack of documentation for these flushes. For another resident, a midline was placed and later removed without complications, and the resident received IV antibiotics as ordered. However, there was no documented evidence that the physician was contacted for orders regarding the care and maintenance of the midline during the time it was in place. Additionally, MARs did not show documentation that the midline was flushed with Normal Saline before and after medication administration. The Director of Nursing confirmed both the lack of physician orders for midline care and the absence of documentation for required flushes.
Plan Of Correction
Resident 9 assessed with no noted concerns related to having no documented evidence that her peripheral intravenous catheter was flushed with normal saline solution before and after the administration of her physician-ordered meropenem doses on April 10, 2025 through April 16, 2025. Resident 9's physician was notified regarding the facility having no documented evidence that her peripheral intravenous catheter was flushed with normal saline solution before and after her meropenem doses administered on April 10, 2025 through April 16, 2025. Resident 12 assessed with no noted concerns related to having no physician orders regarding care and maintenance of her midline May 22, 2025 through May 29, 2025, and related to having no documented evidence that her midline was flushed with normal saline solution before and after the administration of her physician-ordered meropenem doses May 22, 2025 through May 29, 2025. Resident 12's physician was notified regarding the facility having no physician orders regarding care and maintenance of her midline May 22, 2025 through May 29, 2025, and related to having no documented evidence that her midline was flushed with normal saline solution before and after the administration of her physician-ordered meropenem doses May 22, 2025 through May 29, 2025. Any resident receiving intravenous medications via a peripheral intravenous catheter has the ability to be affected by this alleged deficient practice. A whole house audit was completed for residents with intravenous catheters to ensure physician orders and documentation are present for flushing the intravenous catheter with saline routinely, including before and after the administration of intravenous medication as per his/her physician order. Any resident having a midline has the ability to be affected by this alleged deficient practice. A whole house audit was completed for residents with midlines to ensure physician orders were obtained for the care and maintenance of the resident's midline. Any resident receiving intravenous medications via a midline has the ability to be affected by this alleged deficient practice. A whole house audit was completed for residents with a midline to ensure physician orders and documentation are present for flushing the midline before and after the administration of intravenous medication as per his/her physician order. Licensed nursing staff, including agency licensed nursing staff, were re-educated on the facility Peripheral medication as per his/her physician order. Any resident having a midline has the ability to be affected by this alleged deficient practice. A whole house audit was completed for residents with midlines to ensure physician orders were obtained for the care and maintenance of the resident's midline. Any resident receiving intravenous medications via a midline has the ability to be affected by this alleged deficient practice. A whole house audit was completed for residents with a midline to ensure physician orders and documentation are present for flushing the midline before and after the administration of intravenous medication as per his/her physician order. Licensed nursing staff, including agency licensed nursing staff, were re-educated on the facility Peripheral Intravenous Access Flushing Policy and the facility Peripheral Intravenous Access Medication Administration Policy, including the importance of obtaining a physician order for routine saline flushing and saline flushing prior to and following the administration of intravenous medications. They were also re-educated on the Peripherally Inserted Central Catheter Line and Midline Maintenance and Care Policy and the Peripherally Inserted Central Catheter Line and Midline Access Medication Administration Policy, including the importance of obtaining a physician order for routine saline flushing and saline flushing prior to and following the administration of intravenous medications. Registered Nurse Charge Nurse/Designee will audit residents receiving intravenous medications via a peripheral intravenous catheter to ensure physician orders are present for routine saline flushes as well as saline flushes before and after intravenous medication administrations three times per week for eight weeks, then monthly until resolved. Findings from audits will be reviewed by the Quality Assurance Performance Improvement Committee for recommendations and/or resolution at its regularly scheduled meetings, focusing on results, areas of improvement, and/or continuation of audits. Registered Nurse Charge Nurse/Designee will also audit residents receiving intravenous medications via a peripheral intravenous catheter to ensure documentation is present on the resident's administration record for routine saline flushes as well as saline flushes before and after intravenous medication administrations three times per week for eight weeks, then monthly until resolved. Findings from audits will be reviewed by the Quality Assurance Performance Improvement Committee for recommendations and/or resolution. Similarly, registered nurses will audit residents receiving intravenous medications via a midline catheter to ensure physician orders are present for routine saline flushes as well as saline flushes before and after intravenous medication administrations three times per week for eight weeks, then monthly until resolved. Findings from these audits will also be reviewed by the Quality Assurance Performance Improvement Committee for recommendations and/or resolution. Finally, registered nurses will audit residents with a midline to ensure documentation is present on the resident's administration record for routine saline flushes as well as saline flushes before and after intravenous medication administrations three times per week for eight weeks, then monthly until resolved. The results and any recommendations will be discussed and reviewed during the committee meetings to determine further actions or continuation of audits.