PRN Medications Administered by QMAs Without Nurse Authorization
Penalty
Summary
The facility failed to ensure that as-needed (PRN) medications administered by Qualified Medication Aides (QMAs) were preauthorized by a licensed nurse, as required by facility policy and job descriptions. For one resident with gastroesophageal reflux disease, ondansetron was administered on two occasions by QMAs without prior authorization from a licensed nurse. The resident's records showed that the medication was given as needed for nausea and vomiting, but there was no documentation of nurse authorization as required. For another resident with generalized anxiety disorder, severe cognitive impairment, and osteoarthritis, both lorazepam and Tylenol Arthritis Pain Extended Release were administered by QMAs on multiple occasions without documented authorization from a licensed nurse. Facility documentation and staff interviews confirmed that QMAs are required to obtain and document nurse authorization before administering PRN medications, but this process was not followed for these residents during the review period.