Failure to Remove Old Medication Patch Prior to New Application
Penalty
Summary
The facility failed to provide care and treatment in accordance with professional standards of practice by not following a physician's order for medication administration for one resident. According to the facility's policy, medications are to be administered as per the written orders of the attending physician. The resident in question was moderately cognitively impaired, required extensive assistance for daily care, and had multiple diagnoses including acute respiratory failure, heart attack, stroke, myasthenia gravis, and dementia. The physician's order specified that a Rivastigmine (Exelon) transdermal patch should be applied once daily and the old patch removed per schedule. Documentation showed that the patch was administered on consecutive days as ordered, with staff indicating the old patch was removed when the new one was applied. However, a late entry nursing note indicated that the resident was found with two Exelon patches on upon arrival at the hospital. Interviews with the LPN who administered the medication and the DON confirmed that, despite the staff member's assertion that she always removes the old patch before applying a new one, the resident was discovered with two patches. The DON acknowledged that, based on the hospital's report and the facility's investigation, the old patch was not removed as required by the physician's order.