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|METHODIST HEALTHCARE MEMPHIS HOSPITALS||1265 UNION AVE SUITE 700 MEMPHIS, TN 38104||June 30, 2017|
|VIOLATION: EMERGENCY SERVICES POLICIES||Tag No: A1104|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Intakes: TN 491
Based on facility policy, training records, medical record review and interview, the facility failed to remove the IV (intravenous needle) for 1 of 1 (Patient # 4) sampled ED (Emergency Department) patients reviewed with an IV access.
The findings included:
1. Review of the facility policy, "Peripheral Intravenous Catheter Guidelines" revealed, "E. DOCUMENTATION: Document details related to peripheral venous access: ... Discontinuation ..." Review of an In-service and Training Record dated May, 2017 revealed, "Please insure that you are removing IV's prior to patient's being discharged -this must also be documented on the depart form."
2. Medical record review for Patient #4 revealed on 5/17/17 at 19:50 (7:50 PM) an INT (Intermittent Needle Therapy) was placed in the left antecubital with a 20 gauge needle. Blood work was drawn and a CT (Computerized Tomography) soft tissue neck with contrast was performed. There was a prominent mental lymph node present measuring 8 mm (millimeters). The patient was discharged home at 21:34 (9:34 PM) on PO (by mouth) antibiotics and Ibuprofen with directions to see her PCP (Primary Care Physician) in the AM. There was no documentation the INT had been discontinued prior to her leaving the ED.
Medical record review for Patient #4 revealed on 5/19/17 at 1:55 PM the patient returned to Hospital #1's ED and was triaged with chief complaint of "was seen here 2 days ago in fast track and was discharged home with an INT in her left arm, went to [Hospital #2] and had it removed. C/o [complaint of] left forearm pain where the INT was, ...Musculoskeletal: Normal ROM [range of motion], Proximal upper extremity: Left, AC [antecubital] region with mild soft tissue swelling and [DIAGNOSES REDACTED] noted. No red streaking or warmth. Radial pulse 3+ ..." Review of the ED Providers note dated 5/19/17 at 3:31 PM revealed, " ...The patient presents with left, arm pain. The onset was 2 days ago. Location: Left arm. The character of symptoms is pain and redness. The degree of pain is moderate. The degree of swelling is minimal ..." Review of the Radiology results revealed, "Findings ...There is superficial venous thrombosis/thrombophlebitis involving a subcutaneous vein on the medial aspect of the elbow at the recent IV site ..."
3. In an interview on 6/23/17 at 1:27 PM via telephone, RN #1 stated, "There was no documentation the INT was taken out. She [Patient #4] called on 5/19/17 and stated she had left with the IV in, went to [Hospital #2] and had it removed. On 5/19/17, the Outcome Coordinator talked to her and she complained of her arm hurting. She returned to our ED, was seen and given prescriptions for antibiotics ..."