Failure to Document and Monitor PICC Line Measurements
Penalty
Summary
The facility failed to provide necessary care and services related to the maintenance and monitoring of peripherally inserted central catheter (PICC) lines for two residents. For one resident, the facility did not measure the length of the PICC line on the date specified by the physician's order, nor did they establish a baseline measurement upon admission, as confirmed by both the RN and the Director of Nursing (DON). The resident was observed with a PICC line in place and an undated dressing, and the medical record lacked documentation of the required measurement. The DON acknowledged that baseline measurements are essential to ensure the catheter remains intact and has not been dislodged. For another resident, the facility did not obtain or document the PICC line external catheter length and arm circumference measurements upon admission or with subsequent dressing changes, despite the presence of physician's orders for regular dressing changes. The medical record review and interviews with nursing staff confirmed the absence of these measurements, which are necessary to monitor for complications such as infiltration or catheter dislodgement. The DON verified these findings during the investigation.