Failure to Meet Professional Standards in Medication Administration and Documentation
Penalty
Summary
The facility failed to ensure that nursing staff provided services in accordance with professional standards of practice, as evidenced by multiple medication administration errors and documentation discrepancies observed during a recertification survey. In several instances, LPNs documented the administration of medications that were not actually given to residents. For example, one LPN recorded that a topical medication was applied to a resident's foot, but this was not observed during the medication pass. Similarly, another LPN signed off on the administration of an oral antiviral medication that was not given, and a blood thinner that was not administered to another resident. There were also issues with the administration of medications via PEG tube, where an LPN crushed and attempted to administer an enteric-coated medication that was labeled 'do not crush,' and failed to ensure that all medications were fully dissolved and delivered. The LPN did not follow physician orders regarding the required water flushes before and after medication administration, and signed off on the administration of a medication that was not observed to be given. Additionally, there were two active and potentially conflicting orders for a lidocaine patch for one resident, leading to the application of a patch for an extended period without proper clarification until after the surveyor's intervention. Another deficiency involved a resident who reported anxiety and requested a specific dose of lorazepam that had previously been effective. The LPN did not administer the medication, did not document the resident's refusal or request for a different dose, and did not notify the physician as required by facility policy. Review of the medication administration record and narcotic log confirmed that the medication was not given and was instead wasted, with no documentation of communication with the physician or follow-up regarding the resident's request.