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GULF COAST MEDICAL CENTER LEE HEALTH 13681 DOCTORS WAY FORT MYERS, FL 33912 Aug. 24, 2011
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on observation and interview the facility failed to have nursing supervision related to care of Intravenous lines for 4 (Patients #4, #5, #6 and #10) of 17 patients reviewed and random patients in Rooms #3102, #3103, #3107, #3111, #3113, #3114, #3124, #3127, #3131, #3133, #3159, #3160, #3161, and #3163; Patient #4 did not have a dated, time, and initialed dressing for Peripherally Inserted Central Catheter(PICC) line site.

The findings included:

1. On 8/24/11, observations in Room #3102, 3107, 3113, 3124, 3156; and of Patients #4, #5, and #6 failed to have labels on their intervenous (IV) tubing. Random patients in Rooms #3103, #3111, #3114, #3124, #3127, #3133, #3161, #3162, and #3164; and Patient #10 failed to have a label on the IV tubing dated as to when initiated/last changed and in Rooms #3159, #3160, #3161, and #3163; and Patients #5 and #6 the nurse failed to place the correct label on the IV tubing; she placed a Thursday label instead of a Wednesday label (which was also not dated).

The nurses assigned to the random patient rooms were interviewed and confirmed the IV tubing was either labeled incorrectly, not labeled, or labeled without a date. When asked if it was policy/procedure or the norm to not label IV tubing, the nurse assigned to
Rooms #3122-3134 stated "it happens" and the nurse assigned to Rooms 3159-3164 was asked when was the IV tubing due to be changed, she replied "Wednesday" and asked about the labels on the the IV tubing having Thursday labels she stated " There wasn't anymore Wednesday labels so I used Thursday labels."

2. On 8/24/11, observation of Patient #4's (Room # 3125) PICC line site revealed the site had a dressing; however, it was not dated, time, or initialed as to when it was applied.

On 8/24/11 at 12:30 p.m., the nurse assigned to Patient #4 was interviewed and confirmed the dressing was not appropriate as it did not contain a dressing to include a date, time, or initials when it was applied. She confirmed she was unaware of when it had to be changed based on the dressing site.