Failure to Follow Physician Orders for Medication and Treatment Administration
Penalty
Summary
The facility failed to ensure that residents received treatment and care in accordance with professional standards of practice by not following physician orders for medication administration for three residents. For one resident with a history of stroke, aphasia, dysphagia, diabetes, and hemiplegia, the resident's grandson was observed applying hemorrhoidal cream without a physician's order or nurse supervision, contrary to facility policy and physician instructions. Documentation showed that the grandson applied the cream before an order was obtained, and after the order was in place, there was no evidence that a nurse was present during application as required. Another resident, who was cognitively intact but had functional impairments and required set-up assistance with eating, was found with her prescribed 9:00 a.m. medications left at her bedside. The resident reported difficulty taking all pills at once and preferred to take them throughout the day with pudding or applesauce. The nurse responsible for administering the medications confirmed that the medications were left at the bedside and that the resident was not observed ingesting them, which is against facility policy requiring staff to observe medication ingestion and document administration immediately. A third resident with a history of congestive heart failure and pulmonary hypertension continued to receive oxygen therapy after the physician's order for oxygen was discontinued. Nursing progress notes indicated ongoing oxygen administration, and hospice notes documented the resident being found with low oxygen saturation and the oxygen device disconnected. The discontinuation of the oxygen order was later confirmed to have been done in error during a review of physician orders by the Assistant Director of Nursing.