Failure to Provide Required RN Coverage and Supervision of IV Medication Administration
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was scheduled for at least 8 consecutive hours daily, 7 days a week, as required by regulation. Review of staffing schedules and interviews with staff revealed that there were multiple days in May when no RN was present in the facility, and the nursing scheduler confirmed that some schedules were composed entirely of Licensed Practical Nurses (LPNs) without RN coverage. The Assistant Director of Nursing acknowledged that there were days without RN coverage and that the facility was not in compliance with the requirement for daily RN presence. A resident with a history of infection and inflammatory reaction due to an internal joint prosthesis was receiving intravenous antibiotics (Cefazolin) via a PICC line. Medication administration records showed that LPNs, rather than RNs, were administering these IV antibiotics. Staff interviews confirmed that LPNs were not certified to administer IV medications independently and that RNs had not supervised or monitored the administration of IV antibiotics by LPNs for this resident. The facility's own policies and job descriptions require RNs to supervise clinical care and ensure compliance with federal, state, and local regulations. Despite this, the facility's staffing records and staff statements indicated that there were days with no RN coverage, and LPNs were performing tasks outside their scope of practice without RN supervision. This deficiency had the potential to affect all residents in the facility, as confirmed by the census and the nature of the care being provided.