Deficiencies in Pharmaceutical Services and Medication Administration
Penalty
Summary
The facility failed to ensure proper pharmaceutical services for several residents, resulting in multiple deficiencies related to the administration and documentation of controlled medications and adherence to physician orders. For one resident, a controlled medication (hydrocodone-acetaminophen) was administered without immediate documentation in the narcotic record, and the delivery receipt was not signed or dated when received. The nurse confirmed the medication was given before it was properly logged, and the ADON acknowledged that the delivery receipt should have been completed at the time of receipt. Another resident's controlled medication (tramadol) brought from home was found in a medication room without an accompanying narcotic count sheet. The ADON stated that the medication was received by staff during admission, but a new narcotic sheet was not started as required by facility policy. The existing count sheet was from a previous admission and did not reflect the current receipt and handling of the medication. Additionally, a resident with a physician's order for a lidocaine patch to be removed at a specific time was found to have the patch still in place past the ordered removal time. The nurse verified the patch was not removed as scheduled, despite documentation indicating otherwise. Another resident with orders for midodrine and insulin had medications administered outside of prescribed parameters: midodrine was given when blood pressure was above the ordered threshold, and insulin was not administered when blood glucose levels indicated it was needed. These failures were confirmed by staff review of the medical records and interviews.