Unnecessary Administration of Scabies Prophylaxis
Penalty
Summary
The facility failed to ensure that three residents' drug regimens were free from unnecessary medications when Elimite cream, a treatment for scabies, was administered as prophylaxis despite the absence of a scabies diagnosis or outbreak. Resident 1, with a history of diabetes mellitus, chronic pain syndrome, and COPD, was admitted with intact cognitive skills and required supervision for daily activities. The resident received Elimite cream following a physician's order for asymptomatic prophylaxis after a roommate was diagnosed with scabies, despite not being tested or showing symptoms. Resident 2, diagnosed with metabolic encephalopathy, generalized muscle weakness, and unspecified dementia, was dependent on staff for all activities of daily living and also received Elimite cream as a preventive measure. Similarly, Resident 3, with a history of atherosclerosis, chest pain, and cardiomegaly, and moderate cognitive impairment, was given Elimite cream for the same reason. In all cases, the residents did not have a diagnosis of scabies, nor were they tested for the condition prior to administration of the medication. Interviews with nursing staff and the Infection Preventionist confirmed that Elimite was administered to these residents as a precaution after a single positive case of scabies was identified in another resident who had been readmitted from the hospital. The Director of Nursing acknowledged that the facility's policy required scraping and confirmation of suspected cases, and that a scabies outbreak is defined as two confirmed cases. The administration of Elimite in these circumstances was recognized as unnecessary, as there were no new suspected or confirmed cases among the treated residents.