Failure to Administer PRN Medication According to Physician Parameters
Penalty
Summary
The facility failed to provide medications as ordered for a resident with moderate cognitive impairment and an indwelling catheter. The resident had physician orders for furosemide (Lasix) 40 mg to be administered only if there was a 3-pound weight gain overnight, with daily weights to be obtained each morning. Review of the Medication Administration Record (MAR) and corresponding weights revealed that furosemide was administered on three occasions when the resident did not meet the required 3-pound weight gain parameter. Specifically, on two dates, the weight gain was less than 3 pounds, and on another date, the previous day's weight was not recorded, making it impossible to determine if the parameter was met. Nursing staff did not verify that the resident met the ordered parameters before administering the PRN furosemide, as required by facility policy. The nurse responsible for the errors did not clarify the order prior to administration and failed to ensure accurate documentation of weights and medication administration. The facility's consultant pharmacist confirmed that the resident received furosemide in error on three occasions, although it was not considered clinically significant in this case. The facility policy directed that nurses must compare the medication and dosage schedule with the MAR and verify that all physician parameters for administration are met prior to giving the medication.