Failure to Ensure Proper Physician Orders and Maintenance for Peripheral IV Administration
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of intravenous (IV) fluids for two residents by not having proper physician orders in place for the maintenance and rotation of peripheral IV sites. For one resident with diagnoses including COVID-19, myocardial infarction, and hyponatremia, the clinical record showed that IV Ceftriaxone was started for a urinary tract infection. However, there was no corresponding physician order for the IV medication or for the required site maintenance, such as rotating the access site every 96 hours. The resident’s IV site dressing was observed to be 11 days old, and the site was not rotated or removed as per protocol, with the batch order set for IV maintenance not implemented until several days after IV initiation. Another resident, diagnosed with sepsis, a right femur fracture, and chronic obstructive pulmonary disease, was started on IV Ceftriaxone for cellulitis. Similarly, there was no physician order corresponding to the medication administration record, and the batch order set for IV site maintenance was not in place when the IV was started. The IV site was not discontinued within the recommended 96-hour period, and the facility did not provide a written policy for peripheral IV site maintenance when requested. Interviews with nursing staff and the Director of Nursing Services (DNS) confirmed that the required batch order set, which includes parameters for site rotation, flushing, and monitoring, was not implemented at the time of IV initiation for either resident. The DNS acknowledged that the oversight resulted in IV sites remaining in place longer than recommended and that appropriate orders were not obtained for each resident started on a peripheral IV.