Failure to Ensure Resident Swallowed Medications During Administration
Penalty
Summary
A deficiency occurred when a nurse failed to ensure that a resident swallowed their prescribed oral medications during medication administration. The resident, who had diagnoses including coronary artery disease, diabetes mellitus, peripheral vascular disease, and Alzheimer's disease, was cognitively intact according to a recent assessment. During a morning medication pass, the nurse left a cup containing six pills on the resident's over-bed table while the resident was eating breakfast, allowing the resident to take the medications at her own discretion. The resident confirmed that some nurses leave her medications at the bedside, while others do not, and stated she would take them when she was ready. The nurse involved explained that she believed it was acceptable to leave the medications with the resident because the resident was alert and oriented, noting that this was the first time she had done so. However, the Director of Nursing later clarified that the resident had not been assessed for self-administration of medications, and facility policy required nurses to ensure residents swallow their medications and not leave them at the bedside. This failure to follow professional standards of medication administration led to the cited deficiency.