Failure to Ensure PRN Medications Administered Under Licensed Nurse Direction
Penalty
Summary
The facility failed to ensure that as needed (PRN) medications were administered under the direction of a licensed nurse and that proper documentation was maintained for one resident reviewed for pain management. The resident had diagnoses including type 2 diabetes mellitus with diabetic neuropathy, spondylosis of the lumbar region, and pain, and had physician orders for acetaminophen and Norco to be given as needed for pain. Review of the Medication Administration Records (MAR) showed that a Qualified Medication Assistant (QMA) administered both acetaminophen and Norco on multiple occasions without documentation of a licensed nurse's assessment or permission, as required by facility policy and physician orders. Interviews with facility staff, including an LPN, a QMA, and a Clinical Support Nurse, confirmed that the established process required a licensed nurse to assess the resident and authorize PRN medication administration, with this process to be documented in the medical record. Facility policies and the QMA job description also specified that PRN medications administered by a QMA must be done under the direction of a licensed nurse and in accordance with facility procedures. The lack of documentation and failure to follow these procedures led to the deficiency cited in the report.