Unlicensed Staff Applied Medicated Ointment Contrary to Policy
Penalty
Summary
The facility failed to ensure that staff were competent and authorized to apply medicated ointment for a resident who was not participating in a self-administration medication program. The resident, who was cognitively intact and had diabetes, had an active order for Triamcinolone Acetonide ointment to be applied to itchy, dry skin. The care plan did not identify a self-administration program, and documentation indicated the resident did not wish to self-administer medications. Despite this, the treatment administration record showed daily documentation of unsupervised self-administration, while observations and interviews confirmed that nursing assistants, rather than licensed staff, were applying the medicated ointment to the resident. Multiple staff interviews revealed that nursing assistants regularly applied the prescription ointment, with one assistant describing the process and confirming the ointment was kept in the resident's room. The nurse educator and assistant director of nursing both confirmed that there were no trained medication aides on campus and that only licensed staff were permitted to administer medications per facility policy. However, a licensed practical nurse described a practice where nursing assistants could apply medicated creams if the resident confirmed their understanding, after which the LPN would document the administration. This practice was not supported by facility policy, which specified that only certified or licensed staff should administer medications.