Failure to Provide and Follow Parameters for PRN Medications and Missed Doses
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary drugs by not providing proper parameters for as-needed (PRN) pain medications and by not following established parameters prior to medication administration. For two residents, physician orders for PRN pain medications such as ibuprofen and acetaminophen did not specify the pain levels or conditions under which each medication should be administered. Additionally, for another resident, there were gaps in the pain scale coverage for PRN opioid orders, and at times, no parameters were in place for certain pain levels. The Assistant Director of Nursing confirmed that pain parameters should have been established for these medications. The facility also failed to follow medication administration parameters for several residents. One resident received PRN pain medications outside of the prescribed pain level ranges on multiple occasions, as documented in the medication administration records over several months. This included administration of oxycodone for pain ratings that did not match the specified parameters in the physician's orders. Additionally, blood pressure medications with specific hold parameters were administered when the resident's systolic blood pressure was below the threshold, contrary to the physician's instructions. Another resident with a history of hypertension and other chronic conditions had a physician order for hydralazine to be administered when systolic blood pressure exceeded a certain value. However, review of the medication administration records revealed multiple instances over several months where the medication was not given despite blood pressure readings above the ordered threshold. The Director of Nursing verified that these doses were missed, and facility policy required medications to be administered as ordered by the physician.