Failure to Follow Physician Orders for Medication and Treatment Administration
Penalty
Summary
The facility failed to ensure that residents received medications and treatments as ordered by their physicians, as well as according to facility policy. In one instance, a registered nurse did not administer a prescribed heparin flush following a normal saline flush for a resident with a central venous catheter, despite a clear physician order to do so. The nurse was unaware of the heparin flush order, and the Director of Nursing confirmed that nurses are expected to follow physician orders and seek clarification if there is confusion. Another deficiency involved the administration of acetaminophen for pain management. A resident received acetaminophen for pain levels outside the parameters specified in the physician's order, which stated the medication was to be given only for mild pain (level 1-3). The medication was administered for higher pain levels, and the LPN responsible stated that she did not pay attention to the pain level parameters. The DON indicated that nurses are expected to assess pain levels and administer medication accordingly, as outlined in facility policy. Additionally, the facility failed to ensure that a resident's enteral tube dressing was changed daily as ordered. Observation revealed that the dressing had not been changed for several days, and staff interviews indicated confusion regarding responsibility for the dressing change. The wound care nurse and LPNs each believed the other was responsible, and the DON clarified that the wound care nurse should complete and document the dressing change, but nurses should verify and perform the task if it is not done.