Failure to Ensure Proper Post-Inhalation Care for Steroid Medication
Penalty
Summary
A deficiency occurred when staff failed to follow professional standards of practice related to the administration of an inhalation medication for a resident with chronic obstructive pulmonary disease (COPD), arthritis, and hypertension. The resident required extensive assistance with activities of daily living and had a physician's order for Budesonide inhalation suspension via nebulizer, with explicit instructions to rinse and spit after use to prevent oral infections. During a medication administration observation, a trained medication aide prepared and administered the Budesonide nebulizer but did not instruct the resident to rinse her mouth afterward, as required by the physician's order and medication guidelines. The aide confirmed during an interview that she had not seen the order instructions and that it was not her usual practice to instruct the resident to rinse her mouth after using the Budesonide nebulizer. Further interviews with the registered nurse, pharmacy consultant, and director of nursing confirmed the importance of rinsing the mouth after steroid inhalation to prevent infections such as thrush, and all verified that the resident's orders included this instruction. The facility's medication administration policy also required medications to be administered according to physician orders. The failure to instruct and ensure the resident rinsed her mouth after Budesonide administration constituted a failure to meet professional standards and follow physician orders.