Failure to Timely Administer IV Fluids and Maintain IV Access
Penalty
Summary
A deficiency occurred when intravenous (IV) fluids ordered for a resident with multiple complex medical conditions, including non-traumatic brain dysfunction, hyponatremia, cerebral palsy, seizure disorder, and respiratory failure, were not administered in a timely manner. The resident was dependent on a tracheostomy, ventilator, supplemental oxygen, and enteral feeding, and was totally dependent on staff for all activities of daily living. Physician orders were placed for IV fluids to address hypernatremia and dehydration, as laboratory results showed elevated sodium and BUN/creatinine levels consistent with dehydration. Despite the order for IV fluids being placed at 8:30 a.m., the fluids were not started until after 4:00 p.m., resulting in an approximately eight-hour delay. The nurse responsible for the resident could not provide an explanation for the delay in starting the fluids. The resident’s IV line later became dislodged the following morning, and the nurse did not attempt to reinsert the IV, instead contacting the contracted IV team. This further delayed the administration of fluids and prescribed medications, as the contracted team was not immediately available and the resident required both fluids and antibiotics. Documentation revealed inconsistencies in the nurse’s account of the difficulty of IV insertion, as progress notes indicated the initial IV was placed without complication. The delay in reestablishing IV access and the subsequent lack of timely fluid and medication administration contributed to the resident’s transfer to the hospital, where the resident was admitted with septic shock and multifocal pneumonia. The facility failed to ensure continuous and timely IV fluid administration as ordered.