| 2821 |
VALLEY CENTER |
515169 |
1000 LINCOLN DRIVE |
SOUTH CHARLESTON |
WV |
25309 |
2018-11-09 |
726 |
J |
0 |
1 |
KBQP11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, review of the State Board of Examiners for Licensed Practical Nurses, and review of the facility policy, the facility failed to ensure Licensed Practical Nurses (LPN) who performed the skill set of Intravenous (IV) therapy were competent and trained to perform IV therapy within their scope of practice and state regulations. The facility was unable to provide verification of competency and IV training for five (#3, #27, #133, #156 and #177) of 13 LPNs who were performing IV therapy. This practice resulted in Immediate Jeopardy. On 11/08/18 at 4:27 PM, the Administrator and the Director of Nursing (DON) were notified verbally that Immediate Jeopardy existed and began on 10/26/18, when Resident #58 was readmitted with a peripheral inserted central catheter (PICC). According to nurse standards of practice and state regulations, only Registered Nurses and trained LPNs with verification were to perform IV therapy. According to an audit provided by the Administrator and the DON on 11/09/18 at 8:30 AM, LPN #3, #27, #133, #156 and #177 performed IV therapy without having IV training and verification as required by the facility. Immediate Jeopardy was abated on 11/08/18 at 6:47 PM, The facility by completing a full audit of all residents who had IV access that would require IV therapy. The facility revised the staffing schedule to ensure an RN or an IV certified LPN would be performing IV therapy for the four residents with IV access and any newly admitted residents with IV access. Although the Immediate Jeopardy was removed, the facility remained out of compliance at severity level two (no actual harm, with potential for more than minimal harm that is not immediate jeopardy) until LPNs were trained and competent with IV therapy including PICCs (peripheral inserted central catheters which is a thin, soft, long catheter (tube) that is inserted into a vein in the upper arm, leg or neck and positioned in a large vein that carries blood into the heart). See F883 (Facility Assessment), F867 (QAPI) and F684 (Quality of Care) for additional information. Findings included: Review of the State Board of Examiners for Licensed Practical Nurses on 11/06/18 at 3:56 PM, revealed the following: .Licensed Practical Nurses perform duties and procedures for which training has been provided during the 12-month training program. The administration of IV fluids is not a part of the standard curriculum for accredited schools of practical nursing in the state.Each LPN would have to have extra training after graduating and taking state boards. In an interview with staff development Registered Nurse (RN) #15, on 11/06/18 at 4:03 PM, it was revealed she was unaware of the scope of practice related to IV training and verification for LPNs. Interview with RN #15 on 11/08/18 at 10:12 AM, revealed she did not have copies of all of the LPN's IV training and verifications. She stated she should have requested and kept copies when the staff members were hired. An interview was conducted on 11/08/18 at 11:20 AM with RN #15. She stated an audit of LPN staff with IV training and verification was completed on 10/03/18. She stated a portion of the LPN staff were not IV trained. She did not provide the number of LPNs not trained in IV therapy. She notified the DON and the Administrator of the audit result. She stated she would not know which LPN was working out of their scope of practice because she did not have a copy of each LPN's IV to verify training. In an interview with RN #15 on 11/08/18 at 4:40 PM, she revealed she provided orientation for newly hired LPNs. She stated she has the new employees come in for two days of orientation and competency training on medication administration and IV care and competency. She stated, even if an LPN has verification of IV training, the LPN would still need to attend the pharmacy IV course per facility policy. She stated LPNs who were not IV trained should know better than to do something outside their scope of practice. She stated none of the newly hired nurses during orientation IV competency had ever told her they could not touch IVs due to not being trained. On 11/08/18 at 5:41 PM, RN #15 provided the Nursing Qualifications and Education policy regarding IV nursing and the revision was dated 03/15/16. The document was titled, Competency Testing Module. The policy revealed the following: . (the company) licensed nursing staff may perform infusion (IV) therapy activities based on state regulations and must successfully complete a (company) infusion (IV) therapy education program, a current pharmacy vendor provided program or the Test - Out.Newly hired nurses may complete the IV Skills Self-Assessment to evaluate experience.Verification of the nurses' completion of an infusion (IV) education program, ongoing training and skills competency, and attendance at in-services will be maintained in the employee's personnel file. A review of the new orientation Competency Testing module packet for nurses was completed on 11/08/18 at 5:41 PM. The following information was noted: .In order to assure that Nursing is able to deliver quality care in a safe manner. It is necessary to perform competency testing on license nurses. Part of the competency testing listed in the packet was Infusion Therapy Skills. The packet information stated, in order for a license practical nurse (LPN) to perform infusion therapy they must be in compliance with state regulations and must be followed. On 11/08/18 at 6:44 PM, the Administrator stated she had not been aware there were LPNs [MEDICATION NAME] outside of their scope of practice. |
2020-09-01 |