Failure to Properly Assess and Monitor IV Access Devices
Penalty
Summary
The facility failed to ensure that intravenous (IV) access devices were assessed, maintained, and monitored according to professional standards of practice for two residents who were receiving IV therapy. The facility's policy required staff to measure the external length of a Peripherally Inserted Central Catheter (PICC) and the resident's arm circumference upon admission or insertion, and then weekly with dressing changes. However, for both residents reviewed, there was no documentation that these measurements were obtained at admission or during their stay. Additionally, staff did not consistently document the changing of needleless injection caps with dressing changes or daily assessment of the PICC insertion site for signs of complications. For one resident with diagnoses of intervertebral discitis and osteomyelitis who was receiving IV antibiotics, physician orders for PICC maintenance and monitoring were incomplete. The orders did not specify whether the PICC was valved or non-valved, the number of lumens, or the location of the line, and directed staff to use a flush protocol that was inconsistent with facility policy. The resident's care plan did not address the type, location, or required maintenance and monitoring of the PICC. Medication and treatment administration records indicated that staff signed off on daily flushing of the PICC, but it was unclear which protocol was followed, and there was no documentation of required cap changes or site assessments. For another resident with a diagnosis of left lower extremity cellulitis who was also receiving IV antibiotics, physician orders similarly lacked direction for daily monitoring of the PICC insertion site and did not require measurement of the PICC external length upon admission or weekly. The orders also failed to specify whether the PICC was valved or non-valved and the number of lumens. Documentation showed that staff signed for dressing changes and arm circumference measurements, but there was no place to record the actual measurements, and no documentation was found that these assessments were performed. The Director of Nursing Services confirmed the lack of documentation and incomplete orders for both residents.