Failure to Implement and Secure Self-Administration of Medication Procedures
Penalty
Summary
The facility failed to properly implement self-administration of medication (SAM) assessments and procedures for two residents. One resident, who was cognitively intact and had diagnoses including diabetes, heart failure, and arthritis, had a physician's order for a lidocaine patch to be applied at bedtime and removed in the morning. Although the SAM assessment indicated the resident could self-administer medications after nurse setup, observations showed that nursing staff applied and removed the patch daily, and left an open box of lidocaine patches unsecured on the resident's dresser. Staff confirmed that the patches should have been secured in a locked medication drawer and that the resident was not able to apply the patch independently, only remove it. The pharmacy consultant and clinical coordinator both stated that only one patch should be left out at a time and that medications should be stored securely according to the SAM assessment. Another resident, with mild cognitive impairment and diagnoses including an indwelling urinary catheter, heart failure, and hypertension, had orders for topical antifungal medications. The care plan and SAM assessment indicated the resident was not able to self-administer medications. However, observations revealed that tubes of Clotrimazole cream and Nystatin powder were left on the nightstand in the resident's room. The resident reported that staff left the medications out for application, and if not left out, staff would not apply them as only one person could access the locked medications. Staff confirmed there was no order for self-administration and subsequently locked the medications away. Facility policy required that the interdisciplinary team assess each resident's cognitive and physical abilities to determine if self-administration is safe and appropriate, and that self-administered medications be stored securely. The policy also stated that any medications found at the bedside without authorization for self-administration should be turned over to the nurse in charge. The facility did not follow these procedures, resulting in unsecured medications at residents' bedsides and improper implementation of SAM assessments.