Failure to Administer and Document Physician-Ordered Medication as Prescribed
Penalty
Summary
A deficiency occurred when a resident with a history of a right hip fracture, chronic obstructive pulmonary disease, and adjustment disorder did not consistently receive a physician-ordered nicotine patch as prescribed. The resident reported missing the nicotine patch for several days, and on the day of the survey, the patch was not applied during the scheduled medication pass because the resident was in therapy. The Qualified Medication Aide (QMA) responsible for administering the medication documented the patch as given at 10:44 a.m., despite not having applied it until approximately 1:40 p.m. after being reminded by the resident. The electronic medication administration record (eMAR) reflected the patch as administered at the earlier time, not the actual time of application. A review of the medication count revealed a discrepancy, with more nicotine patches remaining in the medication sleeve than should have been present according to the eMAR and administration history. Interviews with the QMA and the Director of Nursing (DON) confirmed that the patch was not administered as ordered and was documented as given before actual administration. The facility's policy requires documentation to occur after medication administration, but this procedure was not followed, resulting in inaccurate medication records and unaccounted patches.