Failure to Follow Infection Control Protocols During Medication Administration
Penalty
Summary
Staff failed to follow infection prevention and control protocols during medication administration. Specifically, a registered nurse did not perform hand hygiene, either by hand washing or using an alcohol-based hand rub, before preparing and between administering oral medications to multiple residents. The nurse was observed handling medications, feeding residents, touching residents and their wheelchairs, and returning to the medication cart without sanitizing hands between residents. Facility policy required thorough hand washing before and after providing resident care, but this was not followed during two observed medication administration times. Additionally, another registered nurse did not sanitize the rubber stopper of a multiple-use insulin vial before preparing an insulin injection for a resident with diabetes mellitus. The nurse removed the insulin syringe from its packaging and inserted it directly into the vial without using an alcohol wipe, contrary to facility policy, which instructed staff to swab the rubber stopper with an alcohol sponge prior to inserting the needle. The resident's care plan for diabetes mellitus also lacked focus areas, goals, or interventions related to the diagnosis.