Crushing and Co-Administration of Delayed Release and Controlled Medications
Penalty
Summary
Licensed Vocational Nurse (LVN) 1 failed to follow professional standards during medication administration for a resident with dysphagia and multiple dependencies in activities of daily living. During a medication pass, LVN 1 crushed a delayed release (DR) divalproex tablet and a lorazepam tablet, mixed the powders together, and administered them with applesauce to the resident. The physician's orders specified that divalproex DR was to be given as a whole tablet, and facility policy indicated that timed release tablets should not be crushed. The resident's medical records indicated a history of dysphagia, requiring a mechanical soft diet and thin liquids, but there was no indication that the resident was unable to swallow whole tablets. LVN 1 acknowledged after the incident that she realized the divalproex DR should not have been crushed and that the medications should have been administered separately to identify any intolerance. The Director of Nursing confirmed that both medications should have been given as whole tablets and not together in crushed form. Facility policies reviewed stated that medications must be administered as prescribed and that timed release tablets are not to be crushed. The failure to adhere to these policies and professional standards resulted in the administration of crushed delayed release medication and the mixing of two medications, contrary to physician orders and facility guidelines.