Failure to Obtain Orders and Care Plan for Implanted Vascular Access Port
Penalty
Summary
The deficiency involves the facility’s failure to obtain and implement physician orders and care planning for an implanted vascular access port for one resident. The resident was admitted with chronic kidney disease, hepatorenal syndrome, and an existing implanted port, but the nursing admission note and readmission summary did not address the port. The resident’s care plan, initiated shortly after admission, included problems related to limited physical mobility and liver disease due to cirrhosis, but did not include any problem, goal, or intervention related to the implanted port. Review of the resident’s physician order sheets for December and January showed no orders for flushing, monitoring, or drawing blood from the implanted port. In February, multiple lab tests (CBC and CMPs) were ordered, and nursing notes from early to mid-February did not document any issues with obtaining these labs. On a later date in February, a nursing progress note documented that the resident was lethargic with poor fluid intake, and the physician ordered IV fluids via the currently accessed port. Subsequent physician orders included a monthly saline flush of the port and IV sodium chloride infusions via the port, but there were still no documented orders for monitoring the port or for blood draws from it. Interviews with staff confirmed that the resident had an implanted port on admission and that there should have been physician orders for flushing, monitoring, and drawing blood from the port, as well as inclusion of the port on the admission assessment and care plan. LPNs, an RN, the DON, and the ADON all stated that implanted ports require specific physician orders and care planning, and that an RN accessed the resident’s port to obtain blood after the lab was unable to obtain an adequate sample, without a documented order to draw blood from the port. The DON acknowledged that the resident came in with a port but initially had no orders for its care and that only one flushing order dated later in the stay was seen, confirming the lack of comprehensive orders and care planning for the implanted port.
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