Failure to Specify Dosage in Physician's Order for Topical Medications
Penalty
Summary
The facility failed to ensure that services provided to a resident met professional standards of quality, specifically regarding the administration of medicated creams for a skin rash. The physician's order for the resident directed staff to mix prednisone cream and antifungal cream and apply to the affected body area every shift, but did not specify the dose or measurement for each cream. This omission left nursing staff without clear guidance on the amount of medication to administer, which is contrary to both professional standards and the facility's own medication administration policy requiring the 'five rights,' including the right dosage. The resident involved had significant medical conditions, including vascular dementia, hemiplegia, type 2 diabetes, and mesothelioma, and was dependent on staff for all activities of daily living. Observations noted the presence of a rash on the resident's abdomen and other body areas. Staff interviews revealed inconsistency in how the creams were applied: one nurse used a measured amount based on personal judgment, while another applied a thin layer to cover the affected areas, also relying on personal judgment. Both nurses indicated that the order was unclear regarding the specific amount to use. The Director of Nursing confirmed that a key component of a prescription is the amount to administer and stated that nurses should clarify incomplete orders with the physician before administering medication. However, the lack of a specified dose in the physician's order was not identified or addressed prior to administration, resulting in the deficiency.