Failure to Maintain Pharmaceutical Services and Medication Administration Standards
Penalty
Summary
The facility failed to maintain proper pharmaceutical services in several key areas. There was no separate record kept for emergency drug usage from the Cubex automated dispensing system, as required by state regulations. The discrepancy summary reports provided by the pharmacy did not include resident names or other necessary details, and the facility did not maintain records for emergency drug usage retrieved from the Cubex. The emergency kit logbook was only used for intravenous kits, and the oral emergency kits had been replaced by Cubex without an appropriate record-keeping system in place. Additionally, the facility did not ensure that two licensed nurses signed off on the disposition of non-controlled drugs, as evidenced by a missing witness signature on the Medication Disposition Log for a drug destruction event. The facility's policy required signatures of both the nurse performing the destruction and a witness, but this was not followed. This lapse was confirmed during interviews and a review of the facility's policy and procedure documents. There were also failures in medication administration and verification processes. Nurses did not consistently check medications received from the pharmacy against physician orders and medication administration records. This resulted in one resident receiving the wrong dose of benazepril and another receiving the wrong formulation of morphine. Furthermore, a nurse crushed medications for a resident without a physician order to do so, despite the resident being on a puree diet for non-medical reasons. The facility lacked a policy on medication administration guidance, and nurses were expected to follow standard nursing practice.