Failure to Ensure Proper PICC Line Management and Documentation
Penalty
Summary
The facility failed to ensure proper management and documentation of a Peripherally Inserted Central Catheter (PICC) for a resident who required prolonged intravenous antibiotic therapy. Observation revealed that an LPN disconnected IV tubing from the resident's PICC line, but there was no documented physician order for the PICC line or for monitoring the site. The resident reported having to return to the hospital to have the IV line replaced and indicated that the dressing on the PICC line was last changed at the hospital several days prior. Review of the nursing admission record noted the presence of an IV but lacked specific details such as size, length, and arm circumference. Additionally, a transfer note documented redness and swelling around the PICC site, which prompted a hospital transfer. Interviews with facility staff revealed a lack of knowledge regarding the need for physician orders for PICC lines and the appropriate frequency for dressing changes. The Nurse Manager was unsure about the requirements for PICC line orders and dressing change intervals, while the Director of Nursing stated that orders should be in place for both the PICC line and its monitoring, and that dressings should be changed every 7 days. Facility policy required regular surveillance and documentation of the PICC site, including dressing changes every 5 to 7 days and monitoring for signs of infection, but these practices were not followed or documented for the resident.