HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 7 patient's (Pt's. #1, and #6-11) clinical records reviewed for intravenous (IV) therapy, the Hospital failed to ensure that the registered nurse (RN) supervised the care provided by ensuring that IV site (peripheral catheter) was changed as required.

Findings include:

1. The Hospital's policy titled, "Intravenous Catheter Insertion and Catheter Care Guidelines" (revised 11/2012) was reviewed on 4/15/21 and required, " ...An intravenous catheter will be inserted by the RN ...Replace peripheral catheters every ninety six (96) hours in adults to prevent phlebitis (inflammation of a vein) ...(Hep-locks-intravenous catheter threaded into a vein, flushed with saline and capped off for later use) every ninety-six hours ..."

2. The clinical record of Pt #1 was reviewed on 4/15/21. Pt. #1 was admitted on 3/15/21 through 3/24/21. The clinical record contained the following:

- A physician's order dated 3/17/21 at 6:11 PM, included, "Normal Saline 0.9% bag 100 ml (milliliters) with Mexofin (cefoxitin sodium) (antibiotic) 2 GM (grams) 200 ml/hr (per hour) IV every 6 hours."

- The Medication Administration Record (MAR) from 3/17/21 at 9:36 PM through 3/24/21 at 9:35 AM, was reviewed and indicated that Pt. #1 received Cefoxitin sodium 2 gm (grams) in Sodium Chloride 0.9% 100 ml at 200 ml/hr rate every 6 hours via right antecubital Hep-Lock.

- The Nursing Notes dated 3/15/21 through 3/24/21, were reviewed and indicated that a 20 Gauge Hep-Lock was inserted in the ED (emergency department) on 3/15/21 in right antecubital. Documentation indicated that the Hep-Lock to the right antecubital was being flushed every shift as required by the assigned RN. However, the clinical record lacked documentation that the Hep-lock was removed and a new one inserted, or that a physician's order was obtained to maintain the existing Hep-Lock beyond the recommended 96 hours.

3. On 4/15/21 at approximately 2:35 PM, an interview was conducted with the Director of Nursing (E #11). E #11 stated that IV sites and Hep-Lock sites require changing every ninety six hours.

3. On 4/16/21 at approximately 9:00 AM, an interview was conducted with a Registered Nurse (RN - E #7). E #7 stated, "The Hep-lock or IV site is required to be changed every 96 hours, and should be documented in the clinical record."