Failure to Clarify Lidocaine Patch Orders Leads to Extended Application
Penalty
Summary
A deficiency occurred when the facility failed to clarify physician orders for lidocaine 4% external pain patches, resulting in the patches remaining on a resident's skin beyond the manufacturer's recommended duration of 12 hours. The resident, who had diagnoses including unspecified pain and diabetic neuropathy, had two active physician orders for lidocaine patches—one for the left side with a specified removal time and one for the right side without a removal time. During medication administration observation, a nurse was seen removing patches that had been in place for approximately 24 hours and immediately applying new ones to the same areas. The nurse stated she was following the order times and did not clarify the removal time for the right-side patch with the physician. Interviews with facility staff, including the nurse, Pharmacy Consultant, Nurse Practitioner, and Director of Nursing, revealed that the orders did not align with the manufacturer's instructions, which require the patch to be removed after 12 hours and not reapplied for another 12 hours. The Pharmacy Consultant and Nurse Practitioner both confirmed that the orders should have specified a 12-hour on, 12-hour off schedule, and the Director of Nursing acknowledged that the orders were not accurate and should have included the removal time. At the time of observation, the resident's skin was intact without redness or irritation.