Failure to Maintain and Change Midline IV Dressing per Policy and Standards
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate care and management of a midline peripheral venous access device in accordance with its own policy and professional standards of practice for one resident. Facility policy required staff to inspect the catheter-skin junction and surrounding area, palpate through the intact dressing for redness, tenderness, swelling, and drainage, note any pain, numbness, or tingling, and change a midline dressing weekly or if soiled, with physician orders specifying dressing type and frequency. CDC guidelines cited in the report recommend replacing transparent dressings on short-term central vascular catheter sites at least every seven days. The resident involved was admitted with osteomyelitis of the sacral/coccyx area and a stage four sacral pressure wound, was cognitively intact, and had IV access for daily IV ceftriaxone for osteomyelitis. The clinical record, including the Medication Administration Record for February and March, showed no physician orders for care and maintenance of the midline access site. The resident’s care plan identified risk for complications related to IV medication and included interventions for staff to observe the right chest wall dressing every shift and to change the dressing weekly, but these interventions were not carried out as required. Surveyor observations on two occasions on the same day showed that the resident had a midline peripheral access site in the right chest wall with a transparent dressing dated more than 30 days earlier, indicating the dressing had not been changed weekly as required. The bottom part of the dressing was not fully adhered to the skin. In an interview, the resident stated that staff had not changed the dressing. There was a lack of documentation to support that the facility had assessed the access site or changed the dressing at least every seven days and as needed, and the DON confirmed that the dressing date showed it should have been changed weekly but was not.
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