Failure to Follow Professional Standards in Medication and Treatment Administration
Penalty
Summary
The facility failed to adhere to professional standards of nursing practice in the administration of treatments and medications for four residents. For one resident, there were multiple instances where skin treatments were not documented as completed, indicating they may not have been administered. Another resident did not receive a scheduled dose of a controlled pain medication, with no documentation explaining the omission or notification to the provider. Similarly, a third resident did not receive a scheduled dose of a controlled medication for anxiety, with no documentation or provider notification regarding the missed dose. Additionally, a fourth resident received insulin injections despite blood sugar levels being below the specified threshold for withholding the medication. The Director of Nursing reported that the facility's Unit Managers were expected to identify missed medications or treatments daily, but an internet outage on a specific date hindered the use of the Electronic Medical Record system, contributing to the medication administration issues. The facility's policy requires medications to be administered according to prescriber orders and within a specific time frame, which was not adhered to in these cases.