Delayed Administration of Prescribed Inhalers Due to Pharmacy Authorization Issues
Penalty
Summary
A deficiency was identified when a resident with a complex pulmonary history, including bronchiectasis, respiratory failure, and COPD, did not receive all prescribed inhaler medications as ordered upon admission. The resident was admitted with orders for Symbicort, Ventolin, and Tudorza Pressair inhalers, but only Ventolin was initially available and administered. Symbicort and Tudorza Pressair were not administered until several days after admission due to delays in obtaining the medications from the pharmacy, as documented in the Medication Administration Record and confirmed by staff interviews. The delay occurred because the pharmacy required authorization from the facility to dispense the high-cost inhalers, and this authorization process was not completed promptly. The pharmacy received the physician's orders in the evening and contacted the facility for authorization, which was not provided until the following days. As a result, the resident did not receive Symbicort and Tudorza Pressair until two to three days after admission, despite having ongoing respiratory symptoms and requiring oxygen therapy. Staff interviews revealed that the LPN notified both the pharmacy and the physician about the missing medications and administered Ventolin as needed for shortness of breath. However, the LPN did not document the administration of Ventolin. The DON acknowledged that the facility could have obtained the medications from a local pharmacy if they were not in stock and that it was the responsibility of the RN Supervisor to ensure timely administration of ordered medications. The physician stated that the resident should have received the inhalers as ordered.