Failure to Administer Physician-Ordered Medications and Treatments
Penalty
Summary
The facility failed to ensure that a resident received medications and treatments as ordered by the physician, in accordance with professional standards of practice. Specifically, review of the Medication Administration Record (MAR) revealed that on two separate dates, there were no licensed staff initials to indicate that the resident received their prescribed Trelegy Ellipta inhalation medication for COPD and Bumex oral tablet for CHF. Interviews with the registered nurse confirmed that there was no documentation showing administration of these medications on the specified dates and times. The resident involved had diagnoses of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and an anxiety disorder, and was assessed as having intact cognitive functioning. The care plans for both CHF and respiratory conditions required administration of medications as ordered. The Director of Nursing acknowledged that the facility failed to administer the medications and treatments as prescribed, which was not in accordance with the facility's own policy and procedure for medication administration.