Failure to Follow Professional Standards in Medication Administration and Safety
Penalty
Summary
Nursing staff failed to follow professional standards in several areas, as observed and documented during the survey. For one resident with a gastrostomy tube, the flush bag used for hydration was not labeled with the date and time it was hung, contrary to facility policy and staff expectations. Both a licensed nurse and the nurse consultant confirmed that the flush bag should have been labeled, and the facility's policy on enteral feedings required documentation of the date and time. In another instance, a nurse did not document a pain assessment before or after administering a scheduled narcotic pain medication to a resident, despite stating that the assessment was performed. The Director of Nursing confirmed that staff are expected to document pain assessments before and after administering pain medication to ensure effectiveness and proper pain management. Additionally, during medication administration, nurses withheld blood pressure medications based on vitals obtained by CNAs without verifying or rechecking the measurements, even when the readings were outside the parameters set by physician orders. The DON stated that vitals should be obtained within 30 minutes of medication administration and that it was acceptable to use CNA-obtained vitals if within this timeframe, but did not expect nurses to verify them. Furthermore, a nurse prepared and administered a hazardous chemotherapeutic medication without wearing gloves or any personal protective equipment, stating she was unaware of special handling requirements and did not see such instructions in the physician's order. The DON acknowledged that special handling instructions were not entered for this medication and that staff are expected to consult the pharmacy if unfamiliar with a medication's handling requirements. OSHA guidelines require safe handling for all hazardous drugs, regardless of administration route.