Failure to Administer Parkinson's Medication on Time
Penalty
Summary
The facility failed to provide pharmaceutical services that ensured the accurate and timely administration of medications for a resident diagnosed with multiple conditions, including Parkinson's Disease, Type 2 Diabetes, Asthma, Hypertension, major depressive disorder, and Epilepsy. The resident had a physician's order for Rytary (Carbidopa-Levodopa) to be administered three times daily for Parkinson's Disease, with the facility's policy requiring medications to be given within one hour before or after the scheduled time. Record review revealed multiple instances over a 14-day period where the resident's Parkinson's medication was administered late, ranging from over an hour to more than five hours past the scheduled time. The care plan specifically noted the need to administer medications as ordered to prevent complications related to Parkinson's Disease. Interviews with the resident, DON, and MD confirmed awareness of the late medication administration. The resident reported increased tremors, difficulty holding objects, and slurred speech when medications were late, particularly with the first and last doses of the day. The DON acknowledged ongoing issues with late medication administration, attributing delays to the use of agency nurses unfamiliar with residents and medication routines. The MD also confirmed knowledge of the problem and emphasized the importance of timely administration for Parkinson's medications. Facility policy review supported the expectation for timely medication administration, which was not met in this case.