Failure to Obtain Orders and Maintain a Resident’s Port-a-Cath
Penalty
Summary
The deficiency involves the facility’s failure to obtain and implement provider orders for the care and maintenance of a resident’s port-a-cath. The resident, who had a history of traumatic brain injury with a persistent vegetative state and severely impaired decision-making, was admitted with a left chest port-a-cath placed in the hospital for future vascular access. The hospital discharge summary documented that the port-a-cath was initially too immature to use and required 7 to 14 days to heal before use, and later hospital documentation indicated the port-a-cath was available for medication administration and had been flushed with normal saline and heparin prior to discharge back to the facility. Despite this, review of physician orders from the time of port placement through the survey period showed no orders related to accessing or maintaining the port-a-cath, and the resident’s care plan contained no plan of care addressing the device. Surveyor observation confirmed the presence of a left chest port-a-cath, and staff interviews revealed a lack of knowledge and action regarding its management. A nurse stated she did not know if there were orders for the port-a-cath and believed only RNs could access and flush it. The Unit Manager, who handled the resident’s readmission from the hospital, reported she did not realize orders were needed to access and flush the port-a-cath and noted that both nurses who reviewed the readmission orders were LPNs. The DON acknowledged that the resident had a port-a-cath due to poor vascular access, that orders should typically be obtained upon admission for care and maintenance, and that the facility had never accessed or maintained the resident’s port-a-cath since placement. The NP confirmed awareness that the resident had a port-a-cath for IV fluids, medications, and blood draws and stated that such devices are usually usable about two weeks after placement and should be accessed and flushed routinely. The NP acknowledged that the port-a-cath had not been accessed or flushed at the facility since its placement in December 2024 and that no orders had been written for its maintenance. She further stated she assumed the hospital had accessed and flushed the port during the resident’s hospitalizations and had only verbally mentioned ordering special needles to nursing staff without following through with orders or physician discussion. Collectively, these actions and inactions resulted in the absence of physician orders, care planning, and routine maintenance for the resident’s port-a-cath over an extended period.
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