Failure to Ensure Drug Regimen Free from Unnecessary Medications Due to Improper Morphine Administration
Penalty
Summary
A deficiency occurred when a resident's drug regimen was not kept free from unnecessary medications, specifically regarding the administration of morphine that was not in accordance with hospice orders. The resident, who had multiple complex diagnoses including tracheostomy, respiratory failure, COPD, diabetes, and several cancers, was under hospice care and had orders for several medications, including morphine for pain and dyspnea. The original morphine order was for 5 mg every four hours as needed, which was later increased to 10 mg every two hours as needed, and then clarified to every four hours as needed. However, the medication administration records (MAR) and narcotic control sheets showed multiple discrepancies in the timing, dosage, and documentation of morphine administration. The review of records revealed that morphine was administered at intervals not consistent with either the original or clarified orders, with doses given as frequently as 20 to 40 minutes apart, and some doses not documented on the MAR or narcotic control sheets. There were also inconsistencies in the administration and documentation of other medications, such as lorazepam. The DON confirmed that the nurse had transcribed the hospice order incorrectly, entering every two hours as needed instead of every four hours as needed, and that morphine was not administered per either order. Additionally, a dose of morphine given shortly before the resident's death was not documented on the control sheet. Throughout the resident's final hours, progress notes indicated ongoing administration of morphine and lorazepam, with varying documentation of effectiveness and resident response. The resident was described as minimally responsive, with signs of pain and terminal restlessness, and ultimately expired with chronic hypoxic respiratory failure and malignancies listed as causes of death. The failure to ensure accurate transcription, administration, and documentation of medication orders, particularly for morphine, resulted in the resident receiving unnecessary drugs and doses not in accordance with hospice or physician orders.