Failure to Follow Physician Orders for IV Dressing Changes and Medication Parameters
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders for intravenous (IV) dressing changes and medication management for multiple residents. For two residents with peripherally inserted central catheters (PICCs), observations revealed that the dressings covering the insertion sites were not changed within the required timeframe specified by physician orders and facility policy. One resident's PICC dressing was dated twelve days prior, despite an order to change it weekly, and staff interviews confirmed the dressing should have been changed earlier. Another resident's PICC dressing was also not changed within the seven-day interval required by both physician order and facility policy, as confirmed by staff and the DON during interviews. Additionally, the facility failed to ensure medication was administered according to physician-ordered parameters for a resident prescribed Carvedilol for hypertension. The medication was administered multiple times when the resident's systolic blood pressure was below the ordered threshold, contrary to the physician's instructions to hold the medication if the systolic blood pressure was less than 135. Staff interviews indicated confusion regarding the interpretation of the order's parameters, and the DON acknowledged that medications were given outside of the specified parameters. The facility's policy requires medications to be administered as ordered by the physician and in accordance with professional standards of practice.