Failure to Follow Safe and Sanitary Medication Administration Practices
Penalty
Summary
During medication administration observations, Employee 5 was seen donning gloves and then touching multiple surfaces of the medication cart with gloved hands. Employee 5 retrieved a blood pressure cuff from the cart, entered a resident's room, and performed a blood pressure check, making contact with the resident's skin. Without removing the soiled gloves, Employee 5 proceeded to prepare medications for the same resident, dispensing Vitamin D3 tablets from a multi-dose container and using a gloved finger to prevent a tablet from falling out while pouring it into a medication cup. The medications were then administered to the resident. Following this, Employee 5 used the same gloves to perform a blood pressure check on a second resident and then prepared and crushed medications for that resident. During this process, a tablet fell onto the medication cart, and Employee 5 picked it up with the soiled gloved hand and placed it in the crushing packet before administering the medications. Hand hygiene and glove removal were only performed after these tasks were completed. The Director of Nursing confirmed that Employee 5 should not have handled medications with gloves that had contacted unclean surfaces.