Failure to Remove Discontinued Medications and Follow Physician Orders for Medication Administration and Lab Testing
Penalty
Summary
The facility failed to ensure proper provision of pharmaceutical services to meet the needs of residents, as evidenced by the improper storage and handling of discontinued medications and failure to follow physician orders. During inspections, surveyors observed four discontinued bags of 0.45% normal saline and one discontinued IV bag of vancomycin stored in the medication room and refrigerator, respectively, despite being no longer needed for the residents for whom they were ordered. Additionally, a discontinued blister card of ondansetron and a discontinued blister card of generic Norco were found in the medication cart, available for use, even though both medications had been discontinued by physician order. Staff interviews confirmed that these medications should have been removed and stored separately or discarded according to facility policy. Further review of medication administration practices revealed that midodrine was administered to a resident with heart failure, chronic kidney disease, and hypertension, even when the resident's systolic blood pressure exceeded the physician-ordered parameter to hold the dose if above 120 mmHg. The Medication Administration Record showed that the medication was given on two occasions when the blood pressure was above the specified threshold, contrary to the physician's instructions. The Assistant Director of Nursing acknowledged that these doses should not have been administered. Additionally, the facility failed to consistently obtain laboratory tests as ordered for a resident with adult-onset diabetes mellitus. The physician had ordered Hgb A1c tests every three months to monitor diabetes management, but there were missed intervals where the test was not completed as required. The Assistant Director of Nursing confirmed that the tests were not performed every three months as ordered. These findings demonstrate failures in medication management, adherence to physician orders, and compliance with facility policies.