Failure to Follow Physician Orders for Medication Administration and Skin Checks
Penalty
Summary
The facility failed to obtain, follow, and clarify physician orders related to medication administration and skin checks for two residents. For one resident with a history of cerebrovascular accident, heart failure, hypertension, and depression, there was a physician order for Midodrine HCL to be administered every eight hours, with instructions to hold the medication if the systolic blood pressure (SBP) was greater than 90. Despite this, the medication was repeatedly administered when the resident's SBP was documented above 90, as evidenced by multiple entries in the medication administration record and nursing notes over two consecutive months. The Director of Nursing confirmed that the medication was given incorrectly and that the physician order had been entered incorrectly, but the deficiency was based on the administration of the medication contrary to the documented order at the time. For another resident identified as being at risk for skin integrity issues and elopement, there was a physician order to check the skin integrity under a roam alert bracelet every shift and document any impairments. Observations revealed that the resident's wanderguard was applied too tightly, making it impossible to assess the skin beneath without removing the device. A licensed nurse had to cut off the device to perform the assessment. Despite this, the treatment administration record showed that the skin check was signed out as completed, and the nurse later confirmed that the check could not have been performed due to the tightness of the device and swelling of the resident's ankle. These deficiencies were identified through review of facility policies, clinical records, direct observations, and staff interviews. The failures involved not following physician orders for medication administration and not properly assessing and documenting skin integrity as ordered, resulting in noncompliance with resident care policies.