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F0658
D

Medication Administered Without Physician Order

Torrance, California Survey Completed on 08-14-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A licensed vocational nurse (LVN) administered 5 milliliters of Geritussin, an over-the-counter cough syrup, to a resident without a physician's order. The resident had a history of chronic obstructive pulmonary disease (COPD), epilepsy, hypothyroidism, and schizoaffective disorder, and was assessed as having moderately impaired cognitive skills, requiring assistance with daily activities. The LVN stated that she gave the medication due to the resident's cough and believed that, as an over-the-counter medication, it did not require a physician's order. Upon review, the LVN confirmed there was no physician order for Geritussin in the resident's records and was unsure of the facility's policy regarding administration of over-the-counter medications without a physician's order. The Director of Nursing (DON) confirmed that it was not the facility's practice or standard of care to administer any medication, including over-the-counter drugs, without a physician's order. The facility's policy and procedure on medication administration, revised in November 2017, specified that medications are to be administered by licensed nurses only as ordered by a physician and in accordance with professional standards of practice. The DON also noted that the LVN should have notified the physician about the resident's cough and obtained an order prior to administering the medication.

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