Failure to Measure Arm Circumference for Residents with IV Catheters
Penalty
Summary
The facility failed to ensure the safe and appropriate administration of IV fluids by not measuring the upper arm circumference for two residents with intravenous catheter devices as required by facility policy. For one resident with a midline catheter in the right upper arm, the medical record did not show documentation of the arm circumference measurement upon admission, nor was it measured during the resident's stay. The care plan for this resident included monitoring for signs of infection and complications at the IV site, but the required measurement was omitted. During interviews, nursing staff confirmed that the arm circumference was not measured and that the orders for dressing changes referenced a PICC line instead of the correct midline catheter. Another resident with a PICC line in the right upper arm also did not have documentation of the arm circumference measurement upon admission, despite physician orders and care plan interventions specifying this requirement. The resident was receiving IV antibiotics through the PICC line, and the care plan addressed the risk for IV-related complications, including infection and swelling. Nursing staff verified that the measurement was not performed or documented, acknowledging that it should have been done to monitor for complications. Facility policy required that upper arm circumference be measured three inches (10 cm) above the insertion site upon admission for residents with midline or PICC lines. The failure to perform and document these measurements for both residents was confirmed through medical record review, staff interviews, and observation, and was acknowledged by facility leadership.