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Based on observation, interview and record review the facility failed to provide an organized nursing services when (3) three out of (3) three patient's Intravenous tubing were not labeled to indict when they had been first put in use, and the facility did not have a clear monitoring and care policy for the changing of the Intravenous (IV) tubing to prevent the risk of infections from the extended use of the IV tubing. (Patients #1,2 and 3)

Findings Include:

Observations made on the afternoon of 12/4/17, on the Orthopedic Nursing Unit revealed Patient #3, in Room 8918, with an IV pump with (2) two IV fluids hanging, the IV tubing was not labeled when it had been hung.

Observations made on the afternoon of 12/4/17, on the Orthopedic Nursing Unit revealed Patient #2, in Room 8904, with an IV pump with (3) three IV fluids hanging, the IV tubing was not labeled when it had been hung.

Observations made on the afternoon of 12/4/17, on the Orthopedic Nursing Unit revealed Patient #1, in Room 8905, with an IV pump with (1) one IV fluid hanging, the IV tubing was not labeled when it had been hung.

During a tour of the Facility's Orthopedic Nursing Unit, Staff #7, Patient Safety Officer confirmed the finds and stated, "The tubing should be labeled..."

During an interview in the afternoon of 12/4/17, in the facility conference room Staff #7, Clinical Education Supervisor when asked how often IV catheter sites needed to be changed stated, "Every 3 days."

During an interview in the afternoon of 12/4/17, on the Orthopedic Nursing Unit, Staff #3, RN when asked how often they change IV catheter sites and IV tubing stated, "We change IV catheter sites every 4 days and the tubing every 24 hours." When asked how did they know when both were first used Staff #3 stated, "We should be labeling them."

During an interview in the afternoon of 12/4/17, on the Orthopedic Nursing Unit Staff #4, RN when asked how often they change IV catheter sites and IV tubing stated, "every 4 days and if your giving continuous IV fluids we change every 72 hours, if its antibiotics we change them every 24 hours." When asked how did they know when both were first used Staff #4 stated, "Hopefully it's labeled.... I'm sure there is a policy...."

During an interview in the afternoon of 12/4/17, on the Orthopedic Nursing Unit, Staff #5, RN when asked how often they change IV tubing stated, "We change intermittent tubing every 24 hours and continuous every 96 hours...."

During an interview in the afternoon of 12/4/17, in the facility conference room Staff #7, Director of Education when asked about the differing answers to the policy on IV tubing labeling stated, "...We use Elsevier for the staff training...there had been an IV policy...."

During an interview in the afternoon of 12/4/17, in the facility conference room Staff #1, Performance Improvement Manager stated, "...Critical care has a policy but I can't find one for Med Surgical..." Staff #1 was unable to locate an IV labeling policy that defined how often the items should be changed.