Failure to Ensure Nurse Competency in IV Medication Administration
Penalty
Summary
A nurse (RN) administered intravenous (IV) Vancomycin to a resident without demonstrating competency in IV medication administration or the use of dial-a-flow tubing. The nurse intentionally set the infusion rate at 250 ml/hr, which was faster than the physician-ordered rate of 150 ml/hr, and did so without notifying nursing management, despite being instructed by the Assistant Director of Nursing (ADON) to wait for a medication pump from the pharmacy. The nurse was not aware of specific infusion reactions associated with Vancomycin, such as Red Man Syndrome, and had not received training on significant medication errors, IV medication administration, or the use of dial-a-flow tubing. No skills assessment had been completed for the nurse regarding IV medication administration prior to this incident. The resident involved had multiple complex medical conditions, including COPD, muscle weakness, depression, difficulty walking, a right great toe amputation, a lower left leg open wound, and a peritoneal abscess. The resident also had severely impaired cognition and was described as confused, combative, and not interviewable at the time of the incident. During the administration of Vancomycin, the IV bag lacked a pharmacy label with the resident's name, dose, and instructions for use, and the nurse stated the label must have fallen off. The nurse did not assess the resident for adverse reactions after the medication was administered at the incorrect rate and moved the resident to the dining room without completing any observations. Facility policy required that nurses demonstrate competency in medication administration, including IV medications, and that all medications be administered as prescribed, with proper labeling and verification. However, the facility did not have documentation of the nurse's competency in IV medication administration or the use of dial-a-flow tubing. The Director of Nursing (DON) confirmed that there was no system in place to double-check IV administration and that the facility relied on the competency of the nurse. The nurse's skills checklist did not include IV medication administration or dial-a-flow tubing competencies, and the nurse had not received any specific training on these procedures.