Failure to Monitor Midlines and Adhere to Medication Administration Parameters
Penalty
Summary
The facility failed to ensure proper monitoring and documentation for residents with midline catheters and did not consistently follow physician orders for medication administration. Specifically, two residents with midlines did not have orders in place for flushing the lines before and after medication administration, nor was there documentation of monitoring the midline sites for infiltration or signs of infection. Additionally, for one resident, there was no documentation regarding the removal of the midline or confirmation that the catheter tip was intact upon removal. These lapses were observed through record review and staff interviews, which confirmed that such monitoring and documentation should have been performed every shift. The facility also failed to follow medication administration parameters for residents prescribed blood pressure medications. One resident received Midodrine HCl despite having systolic blood pressures outside the ordered parameters on multiple occasions, and another resident was administered a hypertensive medication without documentation of a pulse being obtained as required by the physician's order. These deficiencies were identified through review of medication administration records and vital sign reports, as well as staff interviews confirming that medications should be held if vital signs are out of the specified range.