Failure to Follow Professional Standards in Medication Administration
Penalty
Summary
The facility failed to provide care in accordance with professional standards of practice in several areas related to medication administration. For two residents, scheduled medications were not administered as ordered at the scheduled times. In both cases, a licensed nurse administered medications earlier than the scheduled time without proper documentation or provider authorization, and the electronic medication administration record (MAR) did not allow for accurate recording of the actual administration time. The nurse reported giving medications early based on resident preference and convenience, but did not consistently document the reason or obtain a revised order, as required by facility policy and professional standards. For another resident with a gastrostomy tube (g-tube), the nurse failed to check the tube's placement and patency before administering medications, and did not flush the tube with water between each medication as required by facility policy. The nurse stated that she only checked for patency once per shift and did not flush between medications because there was no specific physician order to do so. However, facility policy and interviews with supervisory staff confirmed that placement and patency should be checked before every medication administration and that flushing between medications is necessary to prevent mixing and ensure proper delivery. Additionally, for a resident receiving subcutaneous insulin, the facility did not rotate injection sites as required by professional standards and the manufacturer's guidelines. Review of administration records showed repeated use of the same injection sites over multiple days. Nursing staff and facility leadership acknowledged that injection sites should have been rotated to prevent adverse effects and ensure proper absorption, but this was not done according to the established protocols.