Mt Pleasant Healthcare: Unlicensed Nurses Access PICC Lines - TN

LPN L confirmed to inspectors that she had accessed PICC lines and "performed the Vancomycin" for two residents with bone infections. When asked about IV certification, she said: "I haven't gone anywhere for that. I don't remember any extra training I received here at the facility."

PICC lines are thin tubes inserted into arm veins and threaded to large vessels near the heart. Tennessee regulations specifically restrict licensed practical nurses from administering certain IV medications through central lines, requiring registered nurse oversight for these high-risk procedures.

The violations occurred at Mt Pleasant Healthcare and Rehabilitation, where inspectors found LPNs regularly accessing PICC lines despite lacking proper credentials. The facility houses 64 residents and employs only four registered nurses.

Resident #50 arrived at the facility with osteomyelitis of the vertebra, a serious bone infection of the spinal column. Hospital discharge instructions from February 27 noted: "You are going home with a peripherally inserted central catheter (PICC)."

The resident required daily doses of Vancomycin and Ceftriaxone, powerful antibiotics that demand careful monitoring. LPN L administered both medications through the PICC line on March 7, March 13, and March 15. LPN M also gave the drugs via PICC line on March 15 and March 19.

A second resident, #65, suffered from osteomyelitis and Charcot's joint, a degenerative condition affecting foot bones. This resident received Vancomycin through a PICC line from both unlicensed nurses between March 17 and March 20.

During a March 19 observation, inspectors watched LPN M prepare medications for Resident #50. She told them: "[Named Resident #50] has a PICC line and receiving Rocephin 2 gm, she has been here for 3 weeks, she is receiving the medication for Osteomyelitis of her Spine post her surgery."

A lab technician interrupted to inform LPN M that she couldn't obtain a required blood sample from Resident #65. The nurse suggested the Director of Nursing try drawing blood from the PICC line instead. LPN M explained: "the lab comes every Wednesday to draw troughs."

When asked about her qualifications, LPN M stated: "Yes I can hang the IV, but I can't draw blood from the port." Inspectors watched her don protective equipment, prepare the IV medication, flush the PICC line with 10 milliliters of saline, and hang the antibiotic while monitoring the drip rate.

Employee files revealed minimal training for both nurses. LPN M completed "Peripheral IV Insertion" training on July 19, 2024, observed by a registered nurse. LPN L received similar peripheral IV training on August 8, 2024, but was observed by another LPN rather than an RN.

Neither file contained evidence of specialized PICC line training.

Tennessee's Licensed Practical Nurse regulations explicitly prohibit LPNs from administering "titrated medication and dosages calculated and adjusted by the nurse based on patient assessment and/or interpretation of lab values." The rules also restrict IV push medications to peripheral lines only, not central catheters like PICC lines.

The facility's Director of Nursing defended the practice during a March 20 interview. She claimed: "LPNs can do anything but hang blood products or push medications. They can and have been trained. I have skill check offs; we provide training and skill check offs."

No documentation supported her assertions about specialized PICC training.

The nursing shortage at Mt Pleasant Healthcare compounded the problem. Inspectors found the facility failed to maintain required registered nurse coverage on multiple days in February and March. On March 6, no RNs were scheduled for an entire shift, leaving 64 residents under LPN supervision alone.

The Director of Nursing worked that day but acknowledged she cannot serve as charge nurse when the facility exceeds 60 residents. Federal regulations require at least eight consecutive hours of RN coverage daily.

Staffing records showed similar gaps on February 15 and February 22, with no registered nurse coverage for eight consecutive hours on either date.

A regional nurse arrived during the inspection to present Tennessee's LPN regulations, arguing "Nothing says they cannot" access PICC lines. However, the state rules clearly limit LPN scope of practice for central line procedures.

The facility also violated medication storage requirements. During a March 19 inspection of a medication cart, RN L acknowledged improper storage when surveyors found antacid tablets mixed with eye drops and ear wax removal products stored alongside topical patches.

The Director of Nursing confirmed oral medications should not be stored with eye drops and that ear treatments should be separated from topical medications.

Mt Pleasant Healthcare's policy manual requires "sufficient staff with appropriate competencies and skill sets" to ensure resident safety. The policy specifically mandates that "licensed nurses have the specific competencies and skill sets necessary to care for resident's needs as identified through resident assessments."

The facility assessment policy requires addressing "staff competencies and skill sets that are necessary to provide the level and types of care needed" using "evidence-based, data-driven methods."

Both residents required intensive antibiotic therapy for serious bone infections. Resident #50's osteomyelitis affected the spinal column, while Resident #65 battled both bone infection and degenerative joint disease. Vancomycin requires blood level monitoring to prevent kidney damage and ensure therapeutic effectiveness.

The inspection occurred March 20, documenting violations that put vulnerable residents at risk during complex medical treatments requiring specialized nursing expertise they did not receive.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Mt Pleasant Healthcare and Rehabilitation from 2025-03-20 including all violations, facility responses, and corrective action plans.

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