Medication and ADL Deficiencies in Resident Care
Penalty
Summary
The facility failed to follow up on a physician's order for a medication with a black box warning for one resident. The Director of Nurses (DON) discovered that the resident had not received the medication since admission due to the pharmacy withholding it because of the black box warning. The pharmacy was waiting for a response from the facility, which had not been provided. The DON contacted the Primary Care Provider (PCP), who was uncomfortable making a decision about the medication and advised consulting a specialist. Another deficiency involved the failure to ensure that a resident's activities of daily living (ADLs) were completed and maintained. A Certified Nurses Assistant (CNA) was unsure about the resident's meal schedule and did not provide a snack or meal when the resident missed lunch due to an outing. The resident returned to the facility without having eaten, and staff failed to offer a meal or snack upon her return. The Certified Dietary Manager was not informed of the resident's outing, which would have allowed for meal arrangements to be made. Additionally, a resident was observed in the activities room without hydration for an extended period. Staff interviews revealed that residents should have water available at all times, and hydration should be offered at least once an hour. However, this was not the case for the resident observed. The Director of Nursing expected staff to ensure hydration was available, especially during activities, but this expectation was not met, leading to the deficiency.
Plan Of Correction
Resident #264 had his medication, (HCI) discontinued by order from the Advanced Registered Nurse Practitioner. Residents with black box medication and assisted hydration. Residents whose Activities of Daily Living are dependent on staff for hydration that spend time in the activity rooms were reviewed to ensure the necessary assistance and fluids are being provided while in the activity day rooms. Residents who have scheduled outings have the potential to be affected by not having staff arrange, provide and complete alternative options for meals and/or snacks to accommodate the outing. Current residents with since were evaluated for negative consequences from not being provided a meal or snack with a scheduled outing. The Director of Nursing/Designee in-serviced the licensed and certified nursing staff on the hydration policy including offering and providing assist with fluids, meals and snacks based on the residents' needs and plan of care. This training includes the facility process for residents who have scheduled outings including communicating to the kitchen for timely tray delivery to accommodate the resident needs and preferences with meals, hydration and snacks with the residents on outings as needed. The Dietary Director will educate kitchen staff on the facility process for communicating and accommodating meal or snack delivery for residents with. The Director of Nursing / Designee will complete 5 weekly activity day room observations of residents dependent on staff for hydration to ensure appropriate assist and hydration is being offered to meet the resident's hydration needs.