Intravenous therapy in skilled nursing facilities care heightens clinical and regulatory risk. Surveyors frequently review IV therapy practices to evaluate compliance related to federal quality of care regulations, nursing standards, infection prevention requirements, and facility-specific policies. The questions and answers below highlight key expectations, common survey findings, best practices, and steps to consider to ensure survey readiness.
Q: Who should be administering IV therapy and medications?
A: Responsibility and allowances vary by each state’s licensed nurses scope of practice. Additionally, the following training and competencies must be completed and documented:
- Initial and ongoing IV therapy training
- Annual competency validation
- Education on recognizing complications and adverse reactions
- Training adherent to facility and contracted pharmacy policies and procedures
Q: What components of documentation are required for IV therapy?
A: Documentation should include:
- Provider order (including solution and/or medication, rate, duration and indication for use)
- Type and location of IV access
- Verification of line patency
- Site condition (i.e. signs and symptoms of infection, infiltration, pain, etc.)
- Assessments at least once per shift (or based on facility policy) Include what these should address. If it is the 3 items immediately above, then put Assessments as a heading and have the 3 items listed below.
- Administration record
- Monitoring of resident response and observations of adverse effects or allergic reactions
- Care plan addressing IV therapy including resident-centered indication for use, risks and monitoring, and interventions
Q: What are some common IV related survey deficiencies?
A: Frequent citations related to IV management include, but are not limited to:
- Lack of staff competency or validation
- Missing or incomplete documentation
- Failure to monitor IV sites and resident response
- Poor infection control practices
- IV therapy services provided outside facility or staff’s scope
- Lack of care planning and revisions
Q: What are action steps toward evaluating and maintaining IV therapy compliance?
A: The following survey readiness steps support regulatory compliance and help reduce citation risk related to IV therapy:
- Review and update IV therapy policies and procedures to ensure adherence to professional standards of practice, preparation, insertion, administration, maintenance and monitoring, and infection prevention and discontinuation
- Verify completion and documentation of staff training and competencies upon hire and annually
- Audit documentation for:
- Complete and current provider orders
- Accurate medication administration record documentation
- IV site assessments per policy
- Resident response and monitoring of adverse effects or reactions
- Care plan addressing IV therapy with appropriate interventions
- Complete observations of care to identify infection prevention and control concerns including:
- Hand hygiene and PPE use
- Proper hub and port disinfection
- Timely removal of unnecessary lines
- Surveillance and follow up of IV-related infections
- Identify trends and develop performance improvement plan
Contact Proactive for QAPI program support, clinical nurse consulting and to schedule your 2026 mock survey as part of your New Year compliance and risk management strategy.
Written By:
Liz Wheeler, BSN, RN, CHPN, IPCO, QCP, CDP
Clinical Consultant
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