Failure to Implement PICC/Midline Monitoring and Documentation Requirements
Penalty
Summary
The deficiency involves the facility’s failure to follow its own policy and physician orders for management of PICC and midline catheters, including required measurements and insertion site assessments. One resident was admitted with multiple neurological and infectious diagnoses and had a right arm midline ordered for IV antibiotics. Physician orders and the care plan required midline dressing changes, measurement of arm circumference and exposed catheter length on admission and every seven days, and documentation of insertion site appearance every shift. Surveyors observed that the midline site was covered by a round dry patch (bio-patch) under a transparent dressing, preventing visualization of the insertion tip, and the dressing remained in place with the same date over multiple days. When interviewed, the RN caring for this resident stated she checked only around the area and not the actual insertion site, and she had not performed the dressing change. Review of the EMAR, ETAR, and nursing progress notes for this resident showed no documentation of arm circumference measurements, exposed catheter length, or detailed insertion site monitoring as ordered. The care plan interventions, which included maintaining a transparent dressing, changing it every seven days or as needed, and performing and documenting arm circumference and catheter length measurements after each dressing change, were not carried out or documented as required. A second resident with osteomyelitis and a left arm PICC line for IV vancomycin had similar orders and care plan interventions, including weekly PICC dressing changes, arm circumference and exposed catheter length measurements, and documentation of insertion site appearance and signs of infection every shift. Surveyors observed that this resident’s PICC site was also covered by a round dry patch under a transparent dressing, again obscuring the insertion tip. The nurse manager stated the dressing was changed weekly, and an LPN reported that the night nurse changed the dressing and that staff checked around the site for drainage, but she was unsure where insertion site and dressing change documentation was kept. Record review for this resident likewise showed no documentation of required arm circumference measurements, exposed catheter length, or insertion site assessments every shift, despite facility policy specifying weekly arm circumference and external catheter length monitoring for PICC lines.
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