Failure to Follow Physician Orders for Lidocaine Patch Administration
Penalty
Summary
The facility failed to ensure that medication aides (MAs) and nurses followed physician orders for the administration and removal of a lidocaine patch for a resident with chronic pain and moderately impaired cognition. The resident, who had a diagnosis of age-related osteoporosis and was on a scheduled pain medication regimen, was observed to have two lidocaine patches on her right hip, one dated two days prior and another from the current day. Record review showed that staff had signed off on the removal and application of patches, but the old patch was not removed before the new one was applied, contrary to the physician's order. Interviews with staff revealed that both the MA and RN involved were aware of the requirement to remove the old patch before applying a new one, and both had attended in-service training on medication administration. However, neither noticed the previous patch during their respective shifts. The facility's policy on pharmacy services did not address the specific procedure for patch administration and removal, and the DON confirmed there was no policy in place for patch removal. The failure to remove the old patch before applying a new one was not identified until it was observed by surveyors.