Deficiencies in Timely Treatment and Medication Administration
Penalty
Summary
The facility failed to ensure that residents received treatment and care in accordance with professional standards of practice. For Resident 6, there was a failure to promptly notify the physician regarding changes in treatment. Resident 6, who was admitted with diagnoses including sepsis and acute kidney failure, experienced a delay in the administration of intravenous fluids. Despite a physician's order for STAT blood work and intravenous fluids, the facility did not notify the physician or CRNP of the delay in initiating the treatment, which was not administered until 18 hours after the order was given. Additionally, the facility did not adhere to the timely administration of medications for Resident 7, who was admitted with chronic kidney disease. Resident 7's medications, including Apixaban, Lidocan patches, Bromfenac Sodium Ophthalmic Solution, and Carbidopa-Levodopa, were administered over 60 minutes past the scheduled time on multiple occasions. This delay in medication administration resulted in doses being given closer together than prescribed, potentially compromising the effectiveness of the medications. Interviews with the CRNP and the Director of Nursing confirmed the facility's failure to notify the physician of changes in Resident 6's condition and the delay in treatment. Similarly, the Director of Nursing acknowledged the late administration of medications for Resident 7, confirming the facility's responsibility to ensure medications are administered in accordance with physician's orders.
Plan Of Correction
The facility is not able to retroactively correct the citations for residents 6 and 7. Medication administration times will be reviewed for current residents and adjusted to ensure medications can be delivered on time. If medications are not delivered on time, the physician or physician extender will be notified. Residents with new IV medications/treatments will be reviewed to ensure that the delivery of the ordered medication/treatment and the insertion of the intravenous line are in place to deliver the IV medication/treatment timely. If this cannot occur, the physician or physician extender will be notified. The ADON/designee will re-educate licensed nursing staff on the facility's Medication Administration policy and the Notification of Changes policy. The DON/designee will audit medication administration times weekly to ensure timely delivery of medication per physician's order, and if not delivered timely that the physician was notified. The DON/designee will also review new orders for IV medications/treatments to ensure they are initiated per the physician order, or if this cannot be delivered timely that the physician or physician extender is notified. These audits will be discussed at the monthly QAPI meeting for further review and recommendations.