A resident with dementia, COPD, heart failure, and hypoxic respiratory failure received IV Invanz through a midline catheter, but the chart lacked physician orders for dressing changes, flushing, and monitoring for infection or infiltration. Staff observed the midline dressing dated several days earlier, and RN, ADON, DON, and NP interviews confirmed the absence of orders and that the dressing should have been changed on a routine schedule.
A resident with dehydration, AKI, and hypokalemia had an IV left in the L hand after IV fluids were held, but the site was not flushed as expected and remained in place despite the MD’s verbal direction to remove it. The resident reported tenderness, and surveyors observed redness, dried blood, and discoloration under the dressing. Staff interviews confirmed the IV should have been checked daily, flushed when not running, and removed when no longer needed, but this did not occur.
A resident with encephalopathy, cellulitis, UTI, pressure ulcers, and poor nutritional status had a midline IV catheter placed for NS infusion and then ordered to be flushed q12h when not in use. MAR/TAR entries showed ordered flushes were performed by RNs until an agency LVN documented a flush, after which subsequent nursing notes indicated the midline was no longer present, with no clear record of when or how it was removed. Staff interviews revealed that no practitioner order for discontinuation could be located, and there was no documentation of the removal procedure, catheter integrity, or insertion-site assessment, despite facility policy and leadership expectations that a practitioner’s order and full documentation accompany any midline removal.
A resident with a PICC line for IV antibiotics had no physician orders for PICC maintenance, saline flushes, or dressing changes, and the care plan did not include goals or interventions for PICC use and maintenance. Staff stated they were flushing the line and changing the dressing, but these tasks were not ordered on the MAR or TAR, and the DON acknowledged the PICC care had not been care planned.
A resident receiving IV Cefepime via a midline catheter did not have the IV antibiotic bag labeled with the start date/time or nurse initials, and the IV tubing was not dated, contrary to facility IV therapy policy requiring all IV tubing to be labeled with date, time, and initials and changed at specified intervals. The resident’s active care plan lacked focus areas or interventions related to IV therapy. The LVN who administered the medication acknowledged forgetting to date and initial the IV medication and tubing despite prior in-servicing, and the DON confirmed that nurses were expected to label IV medications and tubing during every antibiotic administration, noting the risk of infection and medication error.
A resident receiving IV Ceftriaxone for a UTI had a PICC line and an IV bag hanging without the bag or tubing labeled with the date, time, and initials. The assigned LVN stated she administered the antibiotic but forgot to label it, and the ADON, DON, and facility IV therapy policy all required IV tubing to be dated, timed, and initialed.
IV therapy was not managed per orders for two residents receiving IV antibiotics. One resident with a central line had a peeling dressing and unlabeled IV bag and tubing, while another resident with a PICC had a half-administered cefazolin bag that was not connected and also lacked date, time, and initials. Staff interviews confirmed the dressing changes and IV labeling expectations, and one LPN stated the resident did not receive the full dose and the physician was not notified.
A resident with a PICC for IV antibiotics and a diagnosis of cellulitis had an order for weekly sterile dressing and cap changes, but staff documented the dressing change as completed even though it was not actually done. Observation showed the PICC dressing was still dated from an earlier date, and staff interviews confirmed the dressing should have been changed weekly and that the documentation was inaccurate.
A resident with osteomyelitis, cellulitis, a stage 4 sacral pressure ulcer, paraplegia, and a PICC line was observed receiving IV vancomycin from a bag that lacked a proper label, showing only a date and RN initials. The bag did not include the resident’s name, medication dose, frequency, or route, despite an active order for vancomycin 1 g IV every 8 hours. The RN reported he had just hung the bag, discarded the original label, and knew the bag should have been labeled with full medication information. The DON confirmed the expectation that nurses ensure IV medication containers are correctly labeled and consistent with facility policy requiring verification of the container’s label against the prescriber’s order.
Missing PICC Flush Orders for IV Antibiotic Administration: A resident receiving IV cefepime for pneumonia had no orders for PICC line flushing before and after medication administration, and the care plan also lacked PICC dressing care, flushing, and IV antibiotic details. The MAR/TAR had no documentation for PICC flushes or IV antibiotic administration, and both the LVN and DON confirmed the chart lacked the needed orders.
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