Failure to Administer Scheduled Medications Prior to Offsite Procedure
Penalty
Summary
A deficiency occurred when a resident with multiple complex medical conditions, including epilepsy, major depressive disorder, quadriplegia, and chronic pain, was not administered his prescribed and scheduled medications prior to leaving the facility for a post-surgical appointment. The resident was nonverbal, received medications via PEG tube, and had a care plan that required timely administration of medications for seizure control, pain management, and behavioral health. On the morning of the appointment, the nurse responsible did not administer the resident's scheduled 9:00am medications, including CarBAMazepine, Keppra, RisperDAL, Venlafaxine, and HYDROcodone-Acetaminophen, marking them as 'Out on Appointment' in the MAR. The nurse stated that the resident left the facility at 7:45am, which was outside the standard medication administration window, and therefore the medications were not given. She also indicated unfamiliarity with the specifics of the appointment and did not consult with the nurse practitioner or physician about adjusting the medication schedule. As a result, the resident underwent a painful procedure without having received his scheduled pain and other essential medications. Upon return, the resident exhibited signs of distress, agitation, and pain, which were not present prior to leaving for the appointment. Interviews with facility staff and the resident's family member confirmed that the resident was calm before leaving but became agitated and in pain after the procedure, with the family member noting the absence of mood and pain medications. The nurse practitioner and assistant director of nursing both acknowledged that the resident should have received his medications before leaving for the appointment, and the facility's policies required anticipation and management of pain and administration of medications as ordered. The failure to administer scheduled medications prior to the appointment constituted a deficiency in providing pharmaceutical services to meet the resident's needs.