Deficiency in Medication Administration Process
Penalty
Summary
The facility failed to ensure that all nursing staff adhered to professional standards of quality during medication administration, as evidenced by the actions of one registered nurse (RN), Staff D. During a medication administration observation, Staff D was seen crushing medications and storing them in the top drawer of a medication cart without having the necessary apple sauce to administer them. She left the cart to retrieve the apple sauce and a laptop computer, which she needed to access the Medication Administration Record (MAR). Upon returning, she was unable to log into the laptop and left again to resolve the issue, leaving the medications unattended for several minutes. Staff D, who had been working at the facility for a month and had recently transitioned from a Licensed Practical Nurse (LPN) to an RN, admitted to the surveyor that she would discard the crushed medications because the resident was not in their room. She also revealed that she had accessed the MAR on another computer located at the nurses' station, rather than having it available on the medication cart as per facility standards. Staff D mentioned that the laptop she was using often gave her problems, and although management was aware, the issue persisted. The Director of Nursing (DON) expressed concern over the incident, noting that medication administration procedures had been recently reviewed and that Staff D was a new nurse. The facility's Administrator confirmed that Staff D had not completed the Orientation Checklist for Professional Staff, which was the responsibility of the Assistant Director of Nursing (ADON), who had been terminated for inconsistent work. A review of Staff D's orientation checklist indicated that she required further education on preparing and organizing for medication administration.
Plan Of Correction
The statement made on this Plan of Correction are not and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all federal and state regulation the center has taken or will take the actions set forth in the following plan of correction. The following plan of correction constitutes the centers allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date indicated. Immediate Corrective Action: Staff D, the Registered Nurse, was immediately pulled from the assignment. On staff D was re-educated by the Director of Nursing on medication administration and management to ensure safe and efficient administration of medications to residents. Dispensing, dose preparation and follow the correct medication administration guidelines. Specific competencies and skill set necessary to provide nursing and related services to meet the residents' needs safely. Identification of other residents potentially affected: Current residents have the potential to be affected; however, based on the resident assessment and observation completed, no resident was affected. Measures: On staff D was provided with competency skills training by the Director of Nursing to ensure staff D possess the competencies and skill sets necessary to provide nursing and related services to meet the residents' needs safely. a. Verifying the five rights of administration: right person, medication, route, time, and dose. b. Prepare: Place medication in cup, if medication needs to be or can be crushed. c. Control: Perform hygiene. Use control measures and standard precautions. d. Administration. e. Documentation. On , licensed nurses were re-educated by the Director of Nursing on medication administration and management to ensure safe and efficient administration of medications to residents. Dispensing, dose preparation and follow the correct medication administration guidelines. Specific competencies and skill set necessary to provide nursing and related services to meet the residents' needs safely. Training and orientation competency skills will be completed for newly hired licensed nurses. On , Relias training on medication administration and management was completed by staff D, registered nurse. On , staff D and completed 1:1 training with senior registered nurse to ensure medication administration processes are followed. Monitoring: The Director of Nursing/nursing team will complete daily audits for 4 weeks and then weekly audits x 3 months to ensure licensed nurses are following the medication administration process and possess competency skill sets to provide nursing and related services to meet residents' needs safely. The Director of Nursing will report the findings to the Quality Assurance Performance Improvement Committee Monthly x 4 months or until the committee determines substantial compliance.