Failure to Follow Professional Standards in Eye Drop Administration
Penalty
Summary
The facility failed to ensure that professional standards of practice were followed during the administration of eye drops for three residents observed during medication administration. Staff, including a registered nurse and a trained medication aide, were observed administering eye drops by placing the tip of the bottle at the inner corner of the eye without pulling down the lower eyelid to create a pocket, as required by professional standards and the facility's own policy. In one instance, a drop was observed to run down a resident's face, indicating improper technique. Both the RN and TMA later confirmed that the correct method involves pulling down the lower eyelid, but admitted they did not do so during administration. The residents involved had significant medical histories, including progressive neurological conditions, hemiplegia or hemiparesis, multiple sclerosis, and glaucoma. Care plans for these residents did not address specific care needs related to their eyes or document any refusals or preferences regarding eye drop administration, despite staff and the DON being aware of at least one resident's reported discomfort with having her face touched. Interviews with staff and the DON confirmed that the expected procedure was not followed and that care plans were incomplete regarding these issues. Facility policy on eye drop administration clearly states that staff should gently pull down the lower eyelid to form a pouch and instill the prescribed number of drops into the pouch near the outer corner of the eye. Staff were either unaware of this policy or did not follow it during observed administrations. The DON confirmed that proper technique is covered during staff orientation and that care plans should reflect any resident-specific refusals or needs, which was not the case for the residents observed.