Delayed Administration of Prescribed Inhalers Due to Pharmacy Authorization Issues
Penalty
Summary
A deficiency was identified when a resident with a history of chronic respiratory conditions, including Chronic Obstructive Pulmonary Disease (COPD), Bronchiectasis, and lung cancer in remission, did not receive all prescribed inhaler medications in a timely manner upon admission. The resident was admitted with physician orders for Symbicort, Ventolin, and Tudorza Pressair inhalers to manage their respiratory conditions. However, the Symbicort and Tudorza Pressair inhalers were not available in the facility until three days after admission, and the initial doses were not administered as ordered. The delay occurred because the pharmacy required authorization from the facility to dispense the high-cost medications, and this authorization process was not completed promptly. The pharmacy received the physician's orders on the evening of admission and contacted the facility for authorization, but the necessary approvals for Tudorza Pressair and Symbicort were not provided until the following days. As a result, the resident only received Ventolin initially, which was available, while the other inhalers were delayed. Nursing staff notified the pharmacy and physician about the missing medications, but the documentation of medication administration was incomplete. Interviews with staff confirmed that the facility did not have the required inhalers on hand and that the process for obtaining and authorizing the medications was not completed in a timely manner. The Director of Nursing acknowledged that the medications could have been sourced from a local pharmacy if not available from the contracted pharmacy, and that it was the responsibility of the nursing supervisor to ensure timely administration of ordered medications. The resident, who was alert and oriented, experienced worsening breathing difficulties during this period and expressed a need for their inhalers.