Failure to Ensure Nurse Competency and Proper Venipuncture Practices
Penalty
Summary
The facility failed to ensure that licensed nurses possessed the specific competencies and skill sets necessary to meet residents' needs, affecting all 42 residents. One incident involved a male resident admitted for rehabilitation after abdominal surgery, where an LPN performed a venous blood draw from the resident's foot without documented evidence of appropriate training or competency in this procedure. The facility did not have a policy or procedure in place regarding venipuncture from non-standard sites, and staff interviews revealed uncertainty about proper protocols and training requirements for blood draws from locations other than the arms or hands. Review of staff records showed that the LPN involved had not received documented training in venipuncture, and her most recent education did not cover this skill. Other nursing staff hired since February of the same year also lacked evidence of training or competency evaluations. Interviews with RNs and the DON confirmed that there was no standard policy or procedure for venipuncture, and that training and competency documentation was missing for several staff members. Staff expressed varying understandings of which anatomical sites were appropriate for blood draws and what training was required. The facility was unable to provide requested policies, procedures, or documentation of training and competency evaluations for licensed nurses, both upon hire and annually. The DON acknowledged the absence of such documentation and stated that, at the time, there was no evidence of licensed nurse training or competency evaluation since February. This lack of a system to evaluate and document nurse competencies contributed to the deficiency identified by surveyors.