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Based on record review, policy review, Idaho Board of Nursing Rules review, AAMA website review, personnel file review, RXlist website review, and staff interview, it was determined the facility failed to ensure intravenous medications were administered in accordance with state law for 1 of 1 outpatients (Patient #42) whose record was reviewed and who received IV medication. This put all patients receiving IV medications at risk of complication by not being administered by a licensed nurse. Findings include:

A facility policy titled, "IV Therapy: Peripheral IV Line," revised 11/2022, stated, "The state of Idaho allows other personnel, other than licensed personnel, to start PIVs, if the facility they work in allows it and there is proof of education and training. Mountain View Hospital allows clinical employees, other than RNs of LPNs to start PIVs after they have completed the required training which consists of an online course and the completion of ten IV starts witnessed by a licensed employee."

A facility policy titled, "Medication Administration," revised 1/2022, stated, "In the instance of intravenous therapy ... only those persons trained, with competency proved by the facility will be allowed to administer such medications, in accordance with state law."

Idaho Board of Nursing Rules 24.34.01, accessed 12/07/22, stated the following, "UAPs may complement the licensed nurse in the performance of nursing functions, but cannot substitute for the licensed nurse." The rules also stated, "UAPs in care settings may assist patients who cannot independently self-administer medications ... Assistance with medication may include: breaking a scored tablet, crushing a tablet, instilling eye, ear or nose drops, giving medication through a pre-mixed nebulizer inhaler or gastric (non-nasogastric) tube, assisting with oral or topical medications and insertion of suppositories." The rules did not speak to delegation of IV insertion and IV therapy to UAP.

According to the AAMA website, accessed 12/07/22, CMAs are credentialed (https://www.aama-ntl.org/medical-assisting/what-is-a-cma). In the state of Idaho, MAs and CMAs do not hold a license.

Patient #42 was a 23 year old pregnant female who was seen in an HOPD urgent care clinic on 7/07/22 for treatment of nausea and vomiting. Her record included documentation that at 4:46 PM, a PIV line was started by a medical assistant. Patient #42 received 1 liter of normal saline through her PIV line, administered by the MA.

According to RXlist.com, accessed 12/07/22, "Normal Saline is a prescription medicine used for fluid and electrolyte replenishment for intravenous administration." (https://www.rxlist.com/normal-saline-drug.htm)

The MA's personnel file, who provided care for Patient #42 on 7/07/22, was reviewed. Competencies for her IV technique were requested in person from the VP of Clinical Services for the urgent care on 12/02/22. Her IV certification from an educational institution was provided but no on the job competencies from the HOPD were provided. An additional telephone call to request the MA's competencies was placed on 12/06/22, 2 business days after survey exit. No call back was received, and no competencies were provided.

The Urgent Care DCS and VP of Clinical Services were interviewed together on 12/02/22 beginning at 8:45 AM, and Patient #42's record was reviewed in their presence. The VP of Clinical Services stated MAs cannot give medication, but they could give saline if they were IV certified. She stated MAs could start an IV if they were certified.

The facility failed to ensure IV medications were administered in accordance with state law and applicable policy and procedures.

Based on record review, policy review, Idaho Board of Nursing Rules, AAMA website review, personnel file review, RXlist website review, and staff interview, it was determined the facility failed to ensure HOPDs met the needs of patients in accordance with acceptable standards of practice. This put all patients receiving services in HOPDs at risk of a negative outcome. Findings include:

Refer to A - 410 as it relates to unlicensed personnel administering IV starts and IV medications in an HOPD.