Failure to Administer Medication per Manufacturer's Directions and Physician Orders
Penalty
Summary
A resident with diagnoses including Parkinson's Disease, functional quadriplegia, COPD, type II diabetes, dysphagia, and a gastrostomy tube was dependent on staff for activities of daily living and was cognitively intact. The resident had physician's orders for Apomorphine HCl (Apokyn) to be administered subcutaneously before meals and as needed for freezing episodes related to Parkinson's Disease, with specific instructions to prime the pen according to the manufacturer's directions before each injection. On one occasion, a registered nurse administered the medication without priming the needle, and upon interview, the nurse stated that priming had never been performed. The facility's policy on subcutaneous injections did not address the need for priming multidose cartridge pens. The resident and a family member reported that the medication was not always administered as ordered, both in terms of timing and use of PRN doses, resulting in more frequent and prolonged freezing episodes. Medication administration records confirmed that PRN doses were not documented during episodes observed by the family. The facility's contracted pharmacist confirmed that failure to prime the pen would result in the resident not receiving the correct dose, especially with small-volume medications, potentially affecting the medication's efficacy. The lack of adherence to administration instructions led to the resident experiencing increased symptoms of Parkinson's Disease and psychosocial harm.