Failure to Obtain Orders for PICC Line Flushes During IV Antibiotic Therapy
Penalty
Summary
The facility failed to obtain physician orders for flushing a percutaneous intravenous central catheter (PICC) with normal saline and heparin for a resident receiving intravenous (IV) antibiotics. The resident, who had diagnoses including diabetic foot ulcer, osteomyelitis, and lower extremity impairment, was admitted with a PICC line for administration of IV antibiotics such as Meropenem and Vancomycin. While there were physician orders for the antibiotics and for monitoring and changing the PICC dressing, there were no documented orders for the administration of saline or heparin flushes to maintain catheter patency. Despite the absence of orders, nursing staff routinely used prefilled saline and heparin flushes labeled for the resident, following the SASH (saline, antibiotic, saline, heparin) protocol before and after administering IV antibiotics. Multiple nurses confirmed during interviews that they administered the flushes based on their training and experience, and because the pharmacy provided the flushes. However, they acknowledged that they should have clarified and obtained specific orders for these flushes from the physician and entered them into the electronic medical record (eMAR). The pharmacy technician stated that flushes were automatically sent when IV antibiotics were ordered, but it was the facility's responsibility to ensure orders for flushes were entered into the eMAR. Both the nurse practitioner and the physician confirmed that explicit orders for saline and heparin flushes should have been in place to ensure proper documentation and administration. The Director of Nursing also acknowledged that, although best practices were followed in administering the flushes, the lack of documented orders constituted a deficiency.