Failure to Follow Physician Order for IV Antibiotic Administration
Penalty
Summary
The facility failed to follow a physician's order for the administration of intravenous (IV) antibiotics for a male resident admitted with an infection and inflammatory reaction due to an indwelling urethral catheter. The physician's order specified Meropenem 1 gram in 50 milliliters of 0.9% sodium chloride to be administered intravenously every 8 hours. However, during observation, the resident was found receiving Meropenem mixed in a 100 ml bag of 0.9% sodium chloride, with the infusion pump set to deliver only 50 ml at 50 ml/hr, which would result in the resident receiving only half the prescribed dose. The Director of Nursing acknowledged that the correct 50 ml IV bag was not available and that the medication was instead mixed in a 100 ml bag. There was no documentation that the physician was notified about the unavailability of the 50 ml bag, the change in volume, or whether infusing 100 ml over one hour was acceptable. Additionally, the facility's policy required confirmation of the medication dose, volume, and rate, but this was not followed as per the physician's order.