Medication Administration and Physician Order Adherence Deficiencies
Penalty
Summary
Surveyors identified multiple deficiencies related to medication administration and adherence to physician orders. In one instance, a resident with diagnoses including protein-calorie malnutrition and dementia was administered Lactobacillus 250mg orally during a medication pass, despite the physician's order specifying Florastor Oral Capsule 250mg (Saccharomyces boulardii) for a limited duration, which had already been discontinued. Both the LPN and the Assistant Director of Nursing initially stated that the two medications were the same, but later clarified that they were only similar, not identical. Another deficiency involved a resident with chronic obstructive pulmonary disease (COPD) and other comorbidities who did not receive prescribed Albuterol inhalation treatments after a certain date. The resident reported that the treatments, which had previously helped her breathe easier, were suddenly stopped without explanation, and staff were unaware of the current orders for Albuterol. The medication administration record confirmed that the treatment was not given as ordered, and staff interviews revealed a lack of knowledge regarding the resident's medication regimen. A further issue was found with a resident diagnosed with hypertension who received Hydralazine 50mg despite physician orders to hold the medication if the systolic blood pressure was below 110 or the heart rate was below 60. Medication administration records showed that the medication was given on two occasions when the resident's systolic blood pressure was below the specified threshold. The regional nurse consultant confirmed that there was no policy in place regarding the administration of blood pressure medications with such parameters, and the medication was administered contrary to the physician's instructions.