Failure to Ensure RN Staffing for IV Medication Administration
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was consistently scheduled to administer a resident's 12:00 AM dose of intravenous (IV) antibiotic, Piperacillin-Tazobactam (Zosyn). Six doses of the resident's Zosyn scheduled for 12:00 AM were either not documented as administered or were documented days later by an RN who was not clocked in at the time the doses were scheduled. The Electronic Medication Administration Record (EMAR) showed that the 12:00 AM dose on one date was not administered, and the EMAR did not indicate the actual time of administration or when the documentation was entered. Additionally, a review of the RN's timecard revealed that she was not present in the facility during several shifts when she documented medication administration. Interviews with facility staff revealed that the process for ensuring an RN was scheduled to administer IV antibiotics was verbally communicated and not documented in writing. The Director of Nursing (DON) stated that RNs were scheduled to be in the building at certain times, but the 12:00 AM dose was assigned to an RN who was not present during those shifts. The Staffing Coordinator confirmed that there was no RN scheduled to be at the facility during the 12:00 AM shift on several dates when the medication was due. The affected resident was being treated for sepsis with shock and a chronic postoperative infection. The facility's records indicated that 56 doses of Zosyn were delivered for the resident, but only 42 doses were documented as administered. The failure to ensure sufficient RN staffing and proper medication administration and documentation led to the cited deficiency under F725 for sufficient nursing staff.