Failure to Administer TPN per Physician Orders
Penalty
Summary
The facility failed to ensure that total parenteral nutrition (TPN) was administered according to physician orders for one resident who required this therapy. The resident, who had diagnoses including intestinal blockage, intestinal fistula, colon cancer, hypertension, and chronic kidney disease, was admitted specifically for TPN therapy. Physician orders specified the administration of a TPN Electrolytes Solution intravenously over a 14-hour period with detailed infusion rates. On one occasion, documentation on the Medication Administration Record indicated that the TPN was not administered, and nursing progress notes confirmed the missed dose, citing the need for an RN to administer the medication and a lack of clarification regarding the order. Interviews with staff revealed that there was confusion among the nursing staff regarding responsibility for clarifying and administering the TPN. The on-call LPN directed the in-house LPN to consult with the RNs present, as RNs were responsible for TPN administration. The Director of Nursing confirmed that two RNs were present and responsible for the administration, and that the TPN solution was available in the facility at the time. Facility policy required verification of practitioner orders for TPN, but the missed administration occurred despite the medication being on site and staff being present.