Failure to Notify Physician of Delayed Medication Administration
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) administered a resident's scheduled 9 a.m. medications at 12:08 p.m., resulting in a delay of over three hours. The LVN did not notify the resident's physician about the late administration, despite facility policy requiring immediate consultation with the physician when there is a significant need to alter treatment. The LVN acknowledged that medications should be administered as ordered due to their time-sensitive nature and admitted that the physician should have been informed of the delay, as the resident might require further treatment or monitoring. The resident involved had multiple complex medical conditions, including hemiplegia, hemiparesis, diabetes, hypertension, a history of cerebrovascular accident (CVA), and was at risk for cardiovascular complications, hypo/hyperglycemia, and bleeding due to anticoagulant therapy. The resident's care plans specifically required medications to be administered as ordered, with monitoring for effectiveness and side effects, and prompt reporting of abnormalities to the physician. The medications delayed included those for stroke prophylaxis, diabetes management, hypertension, and supplements. During interviews, the LVN explained that the delay was due to being occupied with other residents' needs, and confirmed that no notification was made to the physician regarding the late administration. The Director of Nursing (DON) stated that in cases of late medication administration, the nurse should complete a change in condition report, update the care plan, monitor the resident, and notify both the physician and the resident's family. Review of facility policy confirmed the requirement for immediate physician notification when treatment is significantly altered.