Health inspection·February 5, 2025

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a Peripherally Inserted Central Catheter (PICC) line dressing care was completed as per professional standards, and physician order for 1 of 1 resident of a total sample of 7 residents, (#7). Residents Affected - Few Findings: Resident #7, a [AGE] year-old male was admitted to the facility on [DATE]. His diagnoses included acute cystitis with hematuria, urinary tract infection, and chronic systolic (congestive) heart failure. The resident's hospital Discharge Worksheet dated 1/24/25 read, Your PICC/Midline dressing should be changed routinely every 7 days or sooner if becomes wet, soiled or loose. Review of the resident's admission readmission Nursing Evaluation dated 1/29/25 revealed he was admitted from the hospital on 1/29/25. The resident was alert and oriented to person, place, time and event, and had an intravenous (IV) access via a PICC. A PICC is a catheter (small tube) used to give treatments and to take blood. The catheter is inserted into an arm vein . guided through the peripheral vein into a central vein near your heart. (retrieved on 2/14/2025 from www.drugs.com). On 2/05/25 at 12:56 PM, resident #7 was sitting on the side of his bed. A PICC line was noted to the resident's right upper arm, and the dressing was dated 1/24. The resident stated the IV access was placed in the hospital, and he received IV antibiotic via the access for 30 minutes per/dose. He stated the dressing had not been changed since he was admitted to the facility. On 2/05/25 at 1:00 PM, Registered Nurse (RN) A confirmed she was resident #7's assigned nurse. She stated the resident had a right upper arm PICC line and was getting antibiotics every 8 hours for acute cystitis. She verbalized the PICC should be flushed before and after medication administration, and the end should be capped when not in use. RN A said the PICC line dressing should be changed within 24 hours of the resident's admission, and then every 7 days and as needed (PRN) for any soilage. On 2/05/25 at 1:05 PM, an observation of the resident's PICC line dressing was conducted with RN A. She acknowledged the date on the dressing was 1/24. A review of the resident's physician orders was conducted by RN A. She verbalized that an order was in place for the PICC line dressing to be changed every 7 days and PRN. She said the resident's PICC line dressing was not changed as ordered, Page 1 of 3 105673 105673 02/05/2025 Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few since the date noted on the dressing was 1/24. RN A said it should have been changed on 1/31/25 but was not done. Review of the resident's physician orders showed orders dated 1/29/25 for PICC line care that read, PICC line Right arm: Monitor for s/s (signs/symptoms) of infection, swelling, color change, pain, drainage etc. If abnormalities observed, stop use of IV site and notify physician Q (every) shift until 2/19/2025 23:59 (11:59 PM) and as needed. Change dressing within 24 hours of admission, insertion, or reinsertion and Q 7 days and PRN thereafter using sterile technique. Measure arm circumference and external length of catheter. Physician order dated 1/31/25 was for Piperacillin 3.0-375 gm IV Q 8 hrs for cystitis until 2/19/2025. Piperacillin/tazobactam is used to treat a wide variety of bacterial infections. It is a penicillin antibiotic. It works by stopping the growth of bacteria. (retrieved on 2/14/2025 from webmd.com). Review of the resident's Physician/Practitioner progress notes dated 1/30/25 revealed the physician's plan included Routine PICC care. Review of the resident's Medication Administration Record (MAR) revealed documentation on 1/30/25 that indicated the PICC line dressing was changed at 9:40 AM. The date observed on the PICC line dressing was 1/24, not 1/30/25. On 2/05/25 at 1:16 PM, observation of the resident's PICC line dressing was conducted with the East Coast Registered Nurse (RN) Unit Manager (UM). She acknowledged the dressing was dated 1/24 and stated that by protocol the PICC line dressing was to be changed weekly. The RN/UM stated a resident admitted with a Midline/PICC would have batch orders for the care of the Midline/PICC placed in the residents' Electronic Medical Records (EMR). She stated the Midline/PICC line dressing changes should be done by the resident's assigned nurse and explained the PICC dressing for resident #7 should have been changed 24 hours after his admission, and then every 7 days thereafter. On 2/05/25 at 2:20 PM, the Director of Nursing (DON) stated PICC line dressings should be changed if soiled or wet then every 7 days after admission. The resident's MAR was reviewed, and the DON confirmed that signature on 1/30/25 indicated the PICC dressing was changed. The date noted on the resident's PICC dressing was 1/24. She acknowledged the order signed off by Licensed Practical Nurse (LPN) B was for dressing change within 24 hours of admission and every 7 days and as needed thereafter. On 2/05/25 at 2:33 PM, LPN B stated the protocol was to change the PICC dressing if dirty or within 24 hours of admission. The resident's MAR was reviewed with the LPN. She acknowledged she signed the order on 1/31/24 to indicate she had checked the resident's IV access, and not that a dressing change was done. She stated a dressing change was not needed at that point, and noted the PICC dressing was normally changed by an RN not an LPN. LPN B acknowledged th the physician order she signed off on was for dressing change, and stated she should have signed off on the order that instructed staff to monitor the PICC. On 2/05/25 at 3:25 PM, the DON provided a revised policy for Central Lines. She acknowledged that since the date noted on the resident's PICC line dressing was 1/24, the dressing was not changed in the facility since the resident was admitted on [DATE]. A care plan developed for a midline located in the right arm related to infection was initiated on 1/30/25. An intervention was, IV access site maintenance: perform dressing changes, flushes, etc. as 105673 Page 2 of 3 105673 02/05/2025 Indian River Center 7201 Greenboro Dr West Melbourne, FL 32904

F 0694 ordered. Level of Harm - Minimal harm or potential for actual harm The facility's policy Central Lines issued 10/2020, and revised 02/2025 read, Change dressing routinely and per physician orders. Residents Affected - Few 105673 Page 3 of 3