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Based on medical record review, policy review and interview, the facility failed to ensure registered nurses supervised and evaluated nursing care for six of seven medical records reviewed for intravenous site care and patient hygiene/baths (Patients #2, #3, #7, #8 #9 and #10). The total sample was 10 patients.

Findings include:

Review of the facility's Guidelines and Protocols - Clinical policy (Policy #G3, Effective date 09/2012) stated: - Peripheral venous catheters changed with a minimum frequency of every 72 hours; CVC (central venous catheter) dressing changed (label with date, time and initials) with a minimum frequency of weekly and PRN (as needed); IV's (Intravenous) - document peripheral IV/central line site appearance on Daily Data Record (DDR) every shift; Hygiene: Patient bathed (CHG (chlorhexidine gluconate) bath wipes on patients with PICC (peripherally inserted central catheter) or central lines, unless allergic or contraindicated)/hair combed/shaved with a minimum frequency of daily.

1. Review of Patient #10's medical record revealed the patient was admitted to the facility on 05/31/23 and discharged on 06/13/23. The DDR for Patient #10 revealed Patient #10 had the following IV (intravenous) sites:
05/31/23 #20 L (left) FA (forearm) inserted 05/31/23 L wrist
06/01/23 #22 L
06/02/23 #22 L
06/03/23 #22 L
06/04/23 #22 L
06/05/23 #22 L
06/06/23 L
06/07/23 pulled out - #20 L started
06/08/23 #20 L
06/09/23 LFA (left forearm)
06/10/23 LFA
06/11/23 LFA
06/12/23 LFA

The medical record lacked evidence that Patient #10's IV sites were rotated every 72 hours.

The findings were shared with Staff B in an interview on 08/10/23 at 12:32 PM and confirmed.

2. Review of Patient #9's medical record revealed the patient was admitted to the facility on 06/30/23 and discharged on 07/08/23. Medical record documentation revealed the patient was bathed on on 07/01/23 and 07/02/23. There was no documentation in the bath section of the DDR that a bath was given from 07/03/23 through 07/08/23.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

Further review of Patient #9's DDR revealed the patient had the following IV (intravenous) sites:
06/30/23 - #20 L
07/01/23 - #20 L and R (right) chest dialysis catheter
07/02/23 - no documentation
07.03/23 - #20 L hand
07/04/23 - L arm, R chest dialysis catheter
07/05/23 - L arm, R chest dialysis catheter
07/06/23 - R chest dialysis catheter
07/07/23 - R chest dialysis catheter, L Midline
07/08/23 - R chest dialysis catheter, L Midline

The medical record lacked evidence that Patient #9's peripheral IV site was rotated every 72 hours from 06/30/23 through 07/05/23.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

3. Review of Patient #8's medical record revealed the patient was admitted to the facility on 06/23/23 and left AMA (against medical advice) on 06/26/23. There was no documentation in the bath section of the DDR that a bath was given from 06/24/23 through 06/26/23.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

4. Review of Patient #7's medical record revealed the patient was admitted to the facility on 06/22/23 and discharged on 07/08/23. The DDR revealed Patient #7 had the following IV sites:
06/22/23 - 20 gauge left forearm; 22 gauge right hand; 20 gauge right forearm.
06/23/23 - 20 gauge left forearm; 20 gauge right hand; 20 gauge right forearm.
06/23/23 - 20 gauge left forearm; 20 gauge right hand; 20 gauge right forearm.
06/25/23 - 20 gauge left forearm; 20 gauge right hand; 20 gauge right forearm.
06/26/23 - 20 gauge left forearm; 20 gauge right hand; 20 gauge right forearm; PICC (Peripheral Inserted Central Catheter) right upper arm.
06/27/23 - IV access site and type not documented.
06/28/23 - PICC right upper arm; 20 gauge left forearm; 20 gauge right hand; 20 gauge right forearm.
06/29/23 - left heplock; right forearm heplock; right forearm heplock; right PICC.
06/30/23 - Right PICC
07/01/23 - right arm; PICC.
07/02/23 - right arm; PICC
07/03/23 - right upper arm; PICC
07/04/23 - right arm; PICC
07/05/23 - right arm; PICC
07/06/23 - right double PICC; 20 right wrist; 20 right forearm; 20 left upper arm.
07/07/23 - right PICC
07/08/23 - IV access site and type not documented.

The medical record lacked evidence that Patient #7's IV sites were rotated every 72 hours.

The medical record lacked evidence that Patient #7's PICC dressing was changed weekly.

The medical record lacked evidence of documentation of the peripheral IV/central line site appearance every shift.

Interview on 08/14/23 at 2:52 PM with Staff Q and W confirmed the IV access sites and type were not documented per the facility policy.

5. Review of Patient #2's DDR sheets from 08/02/23 through 08/10/23 revealed no documentation in the bath section that the patient received a bath during that time period.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

Further review of Patient #2's DDR sheets from 08/02/23 through 08/10/23 revealed no documentation that the patient's left forearm intravenous site was rotated every 72 hours. There was no evidence that the patient's PICC line dressing was changed every seven days. Patient #2's PICC dressing was changed on 07/23/23. The next documented dressing change for the PICC line was on 08/06/23.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

6. Review of Patient #3's medical record revealed the patient was admitted to the facility on 07/25/23. The DDR for 07/25/23 revealed Patient #3 had two right arm peripheral IV sites and one left arm PICC line. On 07/31/23, Staff G documented Patient #3 stated the two peripheral IVs to her right upper extremity were sore. "She asks that the L (left) upper extremity PICC is the only IV she wants utilized".

Staff G was interviewed on 08/14/23 at 9:50 AM and reported the two peripheral IV sites should have been discontinued.

Review of the DDR from 08/01/23 revealed Patient #3 refused to allow the registered nurse to flush her right forearm IV site. The dressing was intact. Will continue to monitor.

The medical record for Patient #3 did not contain documentation of when the two IV sites to the patient's right arm were discontinued.

Patient #3 was interviewed on 08/14/23 at 11:11 AM. Patient #3 recalled the two IV sites in her right arm were sore and were discontinued a day or two after the soreness started.

The findings were shared in an interview with Staff B and Staff H on 08/14/23 at 2:34 PM and confirmed.

This deficiency represents non-compliance investigated under Complaint Numbers OH00144441 and OH00144429.


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