Failure to Instruct Resident to Rinse Mouth After Steroid Nebulizer Administration
Penalty
Summary
A deficiency occurred when a registered nurse administered Budesonide inhalation suspension via nebulizer to a resident with cognitive impairment, dementia, anxiety, and asthma, but failed to instruct or assist the resident to rinse her mouth after the medication. The resident's care plan required staff to administer medications as ordered, and the medication's instructions specified that the mouth should be rinsed after inhalation to prevent fungal infections. During the observed medication administration, the nurse placed the nebulizer mask on the resident and returned after the treatment, but did not instruct or assist the resident to rinse her mouth. The nurse later confirmed she had not provided this instruction and was unsure if the resident was able to rinse and spit, despite the resident's demonstrated ability to do so during a subsequent observation with a nursing assistant. Interviews with facility staff, including a licensed practical nurse, pharmacy consultant, and director of nursing, all confirmed the importance of rinsing the mouth after steroid nebulizer use to prevent infections such as thrush. The facility's policy required all medications to be administered in a safe and effective manner. The failure to follow this standard of practice for medication administration resulted in the facility not meeting professional standards of quality for this resident.