Failure to Obtain Physician Order for IV Access Prior to Administration
Penalty
Summary
The facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices. Specifically, a resident was admitted with an intravenous (IV) access in place, but there was no physician's order for the IV access upon admission. Nursing staff documented the presence of the IV and administered medications and fluids through it without verifying or obtaining the necessary physician's order for the IV access itself. The resident was later prescribed IV antibiotics, but the order for the IV access remained missing. Further review of the resident's records showed that the care plan did not include interventions to support the need for IV access, and the MDS assessment did not document the IV access in the care plan template. When the initial IV access became occluded, a nurse discontinued it and established a new IV access in a different location, again without a physician's order or notifying the physician of the change. The nurse assumed that an order for IV antibiotics implied an order for IV access, and did not check the physician's orders or contact the physician for clarification. Interviews with facility leadership confirmed that the admission nurse was responsible for securing the order for IV access, and that the lack of an order should have been identified during the review of new admissions and when the antibiotic order was received. The facility's policy required timely physician orders for all treatments and interventions, but this was not followed in the case of the resident who received IV medications and fluids without a physician's order for the IV access.