Failure to Document and Order PICC Line Care for IV Administration
Penalty
Summary
A resident with a history of gram-positive bacteremia and moderately impaired cognition was admitted to the facility with a peripherally inserted central catheter (PICC) line for IV antibiotic administration. The resident's hospital discharge summary indicated the PICC line was placed prior to transfer, and IV antibiotics were administered through this line. However, review of the clinical physician orders, medication administration records (MARs), and treatment administration records (TARs) revealed there were no documented orders or records for routine PICC line care, including site monitoring, flushing to maintain patency, or dressing changes. Progress notes also lacked documentation of these essential PICC line care activities. Staff interviews confirmed that there were no standing orders for PICC line care on the resident's records, and the facility's policy required physician orders for IV fluids and site monitoring. The resident ultimately experienced a PICC line occlusion, resulting in a transfer to the emergency room, where the line could not be unclogged and was replaced with a midline catheter. The absence of documented orders and care for the PICC line constituted a failure to provide safe and appropriate administration of IV fluids and line maintenance.