Failure to Follow Physician Orders for Weights and PICC Line Care
Penalty
Summary
The facility failed to follow physician's orders for daily weights for a resident with multiple diagnoses, including congestive heart failure. The resident was admitted with severe cognitive impairment, and the physician's orders specified daily weights for one week, then weekly weights unless otherwise ordered. Review of the electronic health record showed missing documentation of weights on several specified dates, indicating that the ordered monitoring was not completed as required. During an interview, the Resident Care Manager/Registered Nurse acknowledged that some weights were missed. Additionally, the facility did not adhere to physician's orders regarding medication administration for another resident with endocarditis and a peripherally inserted central catheter (PICC) line. The orders required flushing the PICC line and checking for blood return before each medication administration. During an observed medication pass, a registered nurse flushed the PICC line and started IV antibiotics without checking for blood return as ordered. When questioned, the nurse stated that blood return had been checked the previous day during a blood draw, but not at the time of the medication administration.