Failure to Clarify and Follow Lidocaine Patch Orders
Penalty
Summary
Nursing staff failed to ensure a resident’s drug regimen was free from unnecessary medications by not clarifying the physician’s order for lidocaine 4% transdermal patches. The physician’s order specified that the patch should be applied to the lower back at 9 a.m. and removed at 9 p.m., for a total of 12 hours per day. However, review of the Medication Administration Record (MAR) showed inconsistent application and removal times, including instances where the patch was removed at 9 a.m. or applied at 9 p.m., and on some dates, the patch was applied twice daily at both 9 a.m. and 9 p.m. These actions were not in accordance with the physician’s order or the manufacturer’s instructions. The resident involved had multiple diagnoses, including dementia, major depressive disorder, anxiety, osteoporosis, osteoarthritis, difficulty walking, and a history of falls. The DON confirmed that the lidocaine patch should have been administered once daily as ordered and acknowledged that staff should have clarified the order with the physician. Facility policy required medications to be administered according to prescriber orders and for staff to contact the prescriber if a dosage was believed to be inappropriate or excessive, but this was not followed in this case.