Failure to Follow Venous Port and TPN Administration Policies
Penalty
Summary
The facility failed to follow its policies for care of an implanted venous port for one resident. The facility’s policy required that when a port is accessed, the needle and access site be covered with a transparent sterile dressing labeled with the date, time, and initials of the person performing the procedure. One resident with COPD, heart failure, and hypertension had a physician order to change the venous port dressing weekly, but the baseline care plan did not include instructions for care and management of the venous port. During observation, the resident was seen in bed with a venous port in the left upper chest, and the dressing covering the port was not labeled or dated as required. An RN confirmed that the dressing lacked the required labeling. The facility also failed to properly manage TPN administration for another resident. Facility policy required nursing staff to check the TPN label against the physician order, verify pump delivery settings, and document all. The resident, who had atrial fibrillation, heart failure, and hypertension, had specific physician orders for TPN infusion rates and times. The resident’s care plan noted potential for fluid volume changes related to TPN as the primary hydration source. During observation, the resident was lying in bed with TPN actively infusing via an IV pump, but the TPN bag did not have verification checks of the TPN content, a date it was hung, or the initials of the person who administered it, as required. An RN confirmed the absence of these required verifications and labeling, and the DON acknowledged the failures related to both the venous port and TPN care.
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