QMAs Administered PRN Medications and Insulin Outside Scope of Practice
Penalty
Summary
The facility failed to ensure that Qualified Medication Aides (QMAs) practiced within their defined scope of practice for two residents who were reviewed for unnecessary medications. For one resident with type 2 diabetes mellitus, a QMA administered hydrocodone-acetaminophen, a pain medication, on multiple occasions without prior authorization from a nurse, as required by policy and the QMA scope of practice. The resident was noted to be moderately cognitively intact, and the medication was ordered to be given as needed for pain. For another resident with cerebral palsy, diabetes mellitus, and pain, QMAs administered both insulin and various PRN pain medications, including hydrocodone-acetaminophen, Tylenol, and Excedrin, without obtaining prior authorization from a nurse. The facility's policy did not permit QMAs to administer insulin, even if they were insulin certified. The QMA scope of practice and job description both required that PRN medications only be administered with nurse authorization, and that such administration be properly documented and cosigned by a licensed nurse. These requirements were not followed, as evidenced by the medication administration records and interviews with facility staff.