Failure to Administer Medications as Ordered with Food or Meals
Penalty
Summary
The facility failed to provide pharmaceutical services in accordance with physician orders and facility policy for two of seven sampled residents. For one resident with a diagnosis of hypertension, osteoarthritis, and encephalopathy, the physician's order specified that carvedilol should be administered with food. During a medication administration observation, the nurse gave the resident carvedilol along with other medications but did not provide food at the time of administration. The nurse later confirmed that the medication was not given with food as ordered. For another resident with end stage renal disease, anemia, and syncope, the physician's order required sevelamer to be administered with meals. During observation, the nurse administered sevelamer and other medications in the resident's room without a meal present. The resident later stated that he had eaten breakfast earlier and received his medications almost an hour after eating. The nurse confirmed that medications ordered to be given with meals should be administered accordingly to ensure effectiveness and prevent stomach upset. A review of the facility's policy indicated that drugs must be administered in accordance with the written orders of the attending physician. The failure to administer medications as ordered, specifically with food or meals, was confirmed through observation, record review, and staff interviews.