Medication Disposition Documentation and Nurse Aide Staffing Deficiencies
Penalty
Summary
The facility failed to document the accounting and disposition of medications for a resident who signed out against medical advice. Upon review of the closed clinical record for this resident, there was no evidence regarding the disposition of several prescribed medications, including Atorvastatin, Diltiazem, Methimazole, Mirtazapine, and Lasix. The Director of Nursing confirmed that the facility could not provide documentation of how these medications were handled upon the resident's discharge. Additionally, the facility did not meet the required nurse aide-to-resident ratios for several shifts over a three-month period. Specifically, there were multiple instances during the day, evening, and overnight shifts where the number of nurse aides scheduled was below the minimum required based on the resident census. This was confirmed through a review of staffing records and interviews with facility leadership.
Plan Of Correction
Attempts were made to obtain documented evidence that a disposition of resident #82's medication was completed; however, it was unsuccessful. Education was provided to all registered nurses and licensed practical nurses, conducted by the director of nursing on the implementation of the disposition of medications at the time of discharge. Auditing will be completed with a review of all discharges on a weekly basis for one month and bi-weekly for three months. Findings will be presented to the Quality Assurance Performance Improvement committee for recommendations, an explanation of any identified variance infractions. P 5280 P 5520 There is no evidence of any ill effect on any residents within the community due to lack of adherence to the ratio requirement for the CNA staff on the dates indicated. Current CNA ratios are presented and reviewed at the morning leadership meeting to assure compliance in accordance with the daily DOH Staffing Hours report. Identified concerns are highlighted and discussed with management for additional planning purposes. Outliers are addressed for resolution of the current daily needs. Upon identification of continued staffing needs, immediate mass texts are sent to all current staff including full-time, part-time, and PRN. In addition, needs are posted on agency sites and one-on-one conversations are held with staff to ensure staff needs are met. If continued needs exist, the group will touch base again mid-day to ensure corrective actions have been taken. Also, during the meeting, the following 3 days are reviewed to highlight any potential upcoming outlier concerns. An audit of the DOH Staffing Hour Calculator Report will be reviewed daily for two weeks and weekly for one month at the morning meeting for presentation and discussion of any variances with the established compliance requirements and actions taken to attempt to eliminate any variances. Findings will be presented to the Quality Assurance Performance Improvement committee for recommendations and explanation of any identified variance infractions.