Failure to Follow Midline Catheter and Aspiration Precaution Protocols
Penalty
Summary
The facility failed to follow its own policies and procedures regarding the care and management of a resident with a midline catheter and another resident with aspiration precautions. For one resident with a midline catheter, staff did not measure the upper arm circumference or the external catheter length, did not change the midline dressing in a timely manner, did not provide the required maintenance flush, and did not develop a comprehensive care plan for midline use. The resident reported that the midline dressing had not been changed since admission, and there was no documentation of required measurements or flushing. The Director of Nursing confirmed that these actions were necessary to monitor for complications and should have been documented and care planned according to facility policy. For another resident with a history of hemiplegia, dysphagia, and impaired cognition, the facility failed to ensure that physician orders for aspiration precautions were followed. Despite an active order and posted signage indicating a strict 'no straws' restriction due to aspiration risk, a cup of water with a straw was observed within the resident's reach. Staff confirmed the order and signage but did not remove the straw until prompted. The facility also lacked a policy and procedure for aspiration precautions, as confirmed by the administrator.