Failure to Follow Physician Orders and Infection Control Practices During Topical Medication Administration
Penalty
Summary
A nurse was observed applying Diclofenac External Gel 1% to a resident's left knee, right knee, and right shoulder using her bare hands, without wearing gloves or using the provided dispensing card. The nurse dispensed the medication directly into her hand from a tube that was not labeled for single-resident use and did not have an open date or resident room number. The nurse also placed the medication tube in her uniform pocket and stated that she liked to perform treatments as she moved down the hall with residents. The nurse confirmed that the same tube was used for multiple residents and that she should have used a medication cup for dispensing when treating multiple residents. The facility's infection control policy requires the use of proper technique and equipment to prevent and manage transmission of infections, and all personnel are to be trained on these practices. Additionally, the nurse did not follow the physician's orders as documented in the electronic treatment administration record. The order specified that 2 grams of Diclofenac Gel should be applied to the left knee, right knee, and left shoulder twice daily, not to exceed 16 grams in 24 hours. However, the nurse applied the medication to the right shoulder instead of the left, as the resident refused treatment on the left shoulder and requested it on the right. The nurse admitted she did not contact the physician to clarify or update the order before administering the medication to a different site. The DON confirmed that the expectation is to follow physician orders and use proper infection control techniques.