Failure to Follow Medication Administration and Infection Control Standards
Penalty
Summary
Licensed nursing staff failed to adhere to professional standards and facility policy during medication administration for four residents. Observations revealed that the nurse did not perform hand hygiene between residents, wore elongated acrylic nails, and did not use gloves while preparing medications. The nurse used bare hands and nails during medication preparation, dropped pills onto the medication cart and then placed them into a medication cup without proper sanitation, and prepared medications for two residents in the same room simultaneously, labeling the cups only with bed numbers. This led to a situation where the wrong medication cup was handed to a resident, who questioned the contents, prompting the nurse to exchange the cups without verifying the resident's identity or medication details. Additionally, the nurse left a cup containing a narcotic medication unattended on top of the medication cart and left the cart unlocked while leaving the area on two occasions, contrary to facility policy. These actions were confirmed by the Director of Nursing as not meeting the facility's expectations for medication administration and infection control, as outlined in both state regulations and facility policy.