Failure to Provide Prescribed Medication for Hepatic Encephalopathy
Penalty
Summary
A deficiency occurred when a resident with hepatic encephalopathy and liver cirrhosis did not receive their prescribed rifaximin 550 mg twice daily on multiple occasions due to the medication not being available from the pharmacy. The medication administration record and progress notes documented missed doses on several specific dates. The package insert for rifaximin indicates its use in reducing the risk of overt hepatic encephalopathy recurrence, and the resident was admitted with this diagnosis. On one of the days following missed doses, the resident experienced a change in condition, including increased tremors, confusion, and a decline in self-care, which led to a transfer to an acute care hospital for altered mental status. Hospital records confirmed that the facility had been out of rifaximin for several days prior to the transfer. During an interview, the DON acknowledged the resident's increased confusion and emotional upset when not receiving liver medications and confirmed the pharmacy's practice of sending only a five-day supply due to the medication's high cost.