Deficiency in Agency Nurse Competency and Training
Penalty
Summary
The facility failed to ensure that agency licensed nurses possessed the necessary competencies and skills to meet residents' needs, particularly in medication administration and infection control practices. During a morning medication pass, an agency nurse administered insulin doses after a meal instead of before, and applied lidocaine patches without allowing sufficient time between doses, resulting in medication errors. Another agency nurse did not document shift-to-shift narcotic counts and lacked training in controlled substances management. Additionally, a third agency nurse performed wound care without adhering to enhanced barrier precautions, wearing only gloves instead of the required gown and gloves. Personnel file reviews revealed that competency evaluations for these agency nurses were either incomplete or conducted after they began working at the facility. There was no evidence of training related to medication administration, controlled substances, or enhanced barrier precautions. The Director of Nursing confirmed the lack of adequate training for these agency nurses and acknowledged the need to revise the facility's orientation process for agency staff.
Plan Of Correction
This plan of correction is submitted to comply with federal regulations. This plan is not an admission of guilt, or wrongdoing, nor does it reflect agreement with the facts and conclusions stated in the statement of deficiencies. R132 physician was made aware of the residents insulin given after breakfast instead of before breakfast. E8, E7, and E10 were trained on medication administration, narcotic management, and enhanced barrier precautions by the facility educator/designee. The facility educator/designee provided training on medication administration, narcotic management, and enhanced barrier precautions to licensed agency staff currently coming to the facility. New agency staff will be educated on specific competencies and skill sets as it relates to medication administration, narcotic management, and enhanced barrier precautions prior to working a shift at the facility. The DON/designee will audit new agency licensed nurse personnel files to ensure trainings/competencies have been completed as it relates to medication administration, narcotic management, and enhanced barrier precautions. Audits will be done weekly x 4 weeks and monthly thereafter. The audits will be submitted to the quality assurance committee to determine if further action is required.