Failure to Initiate and Maintain Orders for Implanted Port Care
Penalty
Summary
The deficiency involves the facility’s failure to assess, monitor, and obtain treatment orders for an accessed implanted venous port for a resident from admission through several weeks of stay. The resident was admitted with multiple serious diagnoses, including high-grade papillary urothelial carcinoma status post chemoradiation, abdominal aortic aneurysm, atherosclerotic heart disease, peripheral vascular disease, chronic kidney disease stage 4, COPD, respiratory failure with hypoxia, duodenal ulcer, gastrointestinal hemorrhage, dysphagia, obsessive compulsive disorder, major depression, and presence of a cardiac pacemaker. The admission MDS showed the resident was moderately impaired. Nursing admission notes documented a central IV line on the right chest used for chemotherapy, but review of the medical record showed no physician orders for dressing changes, flushing protocols, or site maintenance from admission through mid-December, and no evidence of ongoing assessment or monitoring of the device during that period. On a later date, a nurse documented that the implanted port was present with a Huber needle in place and that there had been no prior orders for care. Physician orders for monthly flushing with saline followed by heparin were not entered until mid-December. In interviews, a staff nurse stated that the dressing on the IV access was not changed and the port was not flushed because no physician orders had been initiated. The NP confirmed being notified weeks after admission that there were no orders for port management, and the DON acknowledged that the facility did not maintain IV access or perform dressing changes and that physician-ordered interventions were not initiated on admission. The Administrator reported that the oncology provider stated the port had not been maintained appropriately and that the lumen remained in place.
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