Failure to Measure and Administer Topical Medication per Physician Order
Penalty
Summary
A deficiency was identified when staff failed to follow physician's orders and manufacturer’s directions for administering diclofenac sodium topical gel 1 percent to a resident. The physician's order specified that four grams of the gel should be applied to the resident's right knee four times daily, and the manufacturer's instructions required the use of a dosing card to measure the correct amount. During a medication administration observation, an LPN applied the gel to the resident's knee without using the dosing card, instead squeezing unmeasured amounts onto her gloved finger and applying it to the resident’s knee. The resident involved had impaired mobility and was at risk for pain, as documented in the care plan and Minimum Data Set assessment. The LPN confirmed in an interview that she did not use the dosing card, believing it was only provided with prescription strength gel, not the over-the-counter version supplied by the facility’s pharmacy. The DON also confirmed that the gel should have been measured to ensure the correct dose was administered as ordered.