Medications Left Unattended and Administered by Unauthorized Staff
Penalty
Summary
A deficiency occurred when a nurse failed to ensure the secure and proper administration of medications to a resident with severe cognitive impairment. The nurse prepared the resident's medications by mixing them into a cup of coffee and then handed the cup to a certified nurse aide (CNA), instructing the CNA to ensure the resident consumed the coffee containing the medications. The nurse then left the dining room, leaving the medications unattended with the CNA and the resident, rather than remaining present to directly observe the administration as required by facility policy. The resident involved had a history of dementia, major depressive disorder, anxiety disorder, gastroesophageal reflux disease, and unspecified blepharitis, and was assessed as severely cognitively impaired. The resident's care plan included orders for multiple oral medications, some of which were to be crushed and could be mixed with fluids. Facility policy required that staff remain with residents until all medications are taken, especially for those unable to self-administer, and that only licensed nurses administer medications. Observations and interviews confirmed that the nurse did not stay with the resident during medication administration and left the responsibility to a CNA, who is not authorized to administer medications. The nurse was not in direct line of sight when the resident consumed the coffee containing the medications, and the CNA confirmed that the nurse did not return to supervise or remove the cup. The Assistant Director of Nursing acknowledged that the nurse should have remained with the resident to ensure proper administration and that CNAs are not permitted to administer medications.