Failure to Assess Residents for Self-Administration of Medications
Penalty
Summary
The facility failed to ensure that residents were properly assessed for the appropriateness of self-administering medications, as required by policy and regulation. Three residents were observed or reported to have self-administered medications or had medications left at their bedside without a completed assessment or physician order authorizing self-administration. In each case, staff confirmed that no assessment had been completed and no orders were present to allow self-administration, despite the facility's policy requiring both an assessment and a provider order before permitting this practice. One resident, with a history of gastroparesis and dependence for care, was observed independently instilling eye drops at her bedside. Staff confirmed there was no physician order for the eye drops, no assessment for self-administration, and that the resident had a history of having unauthorized items removed from her bedside. Another resident, diagnosed with end stage kidney disease and on dialysis, reported that nurses inconsistently left her chewable tablet (Fosrenal) at her bedside to take after meals, as prescribed. Staff acknowledged that this resident had not been assessed for self-administration, and that the facility did not have a process in place for such assessments, even though the medication was being left for her to take on her own. A third resident, with diagnoses including cancer, heart failure, anxiety, and depression, reported that nurses sometimes left her medications, such as supplements and vitamins, for her to take independently. She recounted an incident where she nearly attempted to pick up a dropped pill herself, despite a history of falls. Staff confirmed that no residents on her unit had been assessed for self-administration of medications. Review of facility policy indicated that an assessment and provider order are required before allowing residents to self-administer medications or have medications left with them, but these procedures were not followed for the residents involved.
Plan Of Correction
1. One of the three residents was found to have medications in their possession. This was retrieved and locked up. Education was provided to residents and assigned nurses regarding self-administration of medication and expectations related to protocol. One affected resident has discharged from the facility. The other two will be assessed for their ability to self-administer medications safely per policy. 2. Any resident has potential to be affected. 3. Education will be provided to admission staff related to self-administration of medication policy, to include asking if the resident has any kind of over-the-counter or prescribed medication in their possession, and explaining expectations related to this policy. Specified scripting will be provided. Education will be refreshed with nursing employees related to the existing self-administration policy. It will be added to new hire orientation checklist for new employee education. An additional step will be added to the new admission checklist to include a discussion with the nurse and resident regarding the self-administration policy. Nurses will be instructed to include a comment in Admission Navigator Section of the EMR to reflect that the conversation was completed. The Self-Administration of Medication policy was updated to include an explanation to residents upon admission related to the policy and its expectations. Five weekly audits will be completed of admission documents and nursing assessments to ensure the policy is discussed as expected for the next 12 weeks. Five verbal weekly audits will also be completed with nurses to seek their understanding of the policy for the next 12 weeks. The Executive Director is responsible for compliance with this policy.