Failure to Ensure Proper Self-Administration of Medications
Penalty
Summary
The facility failed to ensure proper self-administration of medication for two residents. Resident #57, who was cognitively intact with a BIMS score of 13/15, was found with Neosporin ointment on his nightstand, which he used for a rash on his thigh. However, there were no physician orders for this medication, and the resident's assessment indicated he was not to self-administer medications. The primary RN acknowledged the presence of the ointment and explained that medications unknown to the nurse could cause interactions with other medicines. Similarly, Resident #83, also cognitively intact with a BIMS score of 13/15, was found using Voltaren cream for arthritis pain in her knees, which her daughter had brought for her. The cream was discovered in her nightstand drawer, and there were no physician orders for its use. The RN supervisor acknowledged the absence of orders and removed the cream for safekeeping. The DON confirmed that both residents were assessed as not being permitted to self-administer medications, as per facility policy, which requires an interdisciplinary team evaluation and physician orders for self-administration.
Plan Of Correction
Preparation and execution of this plan of correction does not constitute admission or agreement of the facts alleged or conclusion set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by both federal and State laws. F554 Self Admin of meds Medications were immediately removed from rooms for residents #83 and resident #57. Self-administration of medication assessment was completed for resident #57 on Resident #57 was reviewed for the c/o to right side on Skin assessment completed on for resident #57 with no integrity issues. #83 was reassessed for Resident #83 MD was contacted, and new order was obtained cream to. Resident #83 for on discharged home on. An audit of the residents rooms completed by nursing management team did not reveal any additional on over the counter medications or treatments stored at the bedside. All resident self-administration of medications were reviewed to ensure accuracy of self-administration and found to be correct. Resident #57 and the family were educated regarding not having medication at bedside on and to notify the nurse if the resident needs a specific product, so staff is able to assess and to update the physician. Resident #83 discharged home. The licensed staff were in-serviced by the DON and/or designee regarding self-administration of medications, including families should not bring in any over the counter medications and they are required to report to the charge nurse any medications found at bedside. The education will be completed to staff on. Facility will provide education to residents and families via the Monthly Activities Newsletter regarding not to bring in any medications and to notify the nurse if you feel a specific medication is needed so the physician may be notified. This will notify all existing residents. A new process was put in place adding a notice to new admissions packet requesting outside medications not to be brought in and notifying the nurse if something specific is needed. Staff who complete Angel rounds were educated to focus on monitoring for medications at bedside during rounds and to report to the charge nurse any found. Staff also educated to ask the resident if they have any medication not obviously visible in the room. Angel rounds audits will be submitted to the NHA for review upon completion for any reports of medication at bedside. Random weekly audits of 5 resident rooms per floor will be conducted four times a week by the DON and/or designee to ensure any medications are not stored in the residents room without a physicians order. The room audits will be conducted for a minimum of 3 months or until significant compliance is met. The results of the audits will be submitted to the Administrator for review and discussed at the monthly QAPI committee meeting. The committee will direct improvement to the plan when necessary to achieve and maintain compliance.