Failure to Follow Physician Orders and Policy for IV Catheter Care and Maintenance
Penalty
Summary
The facility failed to follow physician orders and its own policies regarding the care and maintenance of PICC lines and Midline intravenous access devices for three residents who required IV medication administration. For one resident with multiple diagnoses including dementia, heart failure, diabetes, and a surgical wound, there were no physician orders for midline catheter care, dressing changes, or required measurements, and no documentation that these interventions were performed during the period IV medications were administered. The resident's care plan also did not address IV care or antibiotic use. Another resident, admitted with a PICC line for IV antibiotics and cognitive impairment, had a care plan that included specific interventions such as assessing for redness, swelling, and changing the dressing weekly. However, documentation showed the PICC line dressing had not been changed for nearly two weeks prior to hospital transfer, and there was no evidence that required measurements or dressing changes were performed or documented. The facility's DON confirmed that the physician order for PICC line care was entered in a way that did not transfer to the MAR, and no documentation could be found for the required interventions. A third resident with a Midline catheter and multiple infections had a care plan that did not address catheter care. While some dressing changes and measurements were documented, there were gaps in documentation for required measurements during dressing changes. Facility policy required dressing changes at least every 7 days and measurement of arm circumference and catheter length, but these were not consistently documented or performed as required.