Failure to Accurately Audit and Document Narcotic Administration
Penalty
Summary
The facility failed to ensure that its narcotics policy was followed by nursing staff, resulting in inaccurate narcotic audits for three residents who were sampled for pain management. Multiple interviews with nursing staff revealed inconsistent practices regarding the receipt, documentation, and storage of controlled substances. Staff described procedures that did not always align with facility policy, such as not consistently obtaining a second nurse to witness the placement of new narcotic cards in the medication cart and not always updating the narcotic count sheets as required. There were also instances where discontinued narcotic cards remained in the medication cart instead of being promptly removed and processed according to policy. A specific incident involved a resident who was prescribed Hydrocodone-Acetaminophen for pain management. The medication was delivered and signed for by an LPN, but the narcotic card was later found missing. Despite extensive searches by multiple staff members, the card was not located until several days later when it was discovered in a shred box with all tablets missing. Review of the resident's Medication Administration Record (MAR) and the Medication Monitoring Control Record revealed discrepancies, including instances where more tablets were documented as pulled from the narcotic cart than were actually administered to the resident. Similar discrepancies were found in the records of two other residents, where medications were subtracted and signed off in the control records but not documented as administered in the MAR. Interviews with residents indicated that they generally received their pain medications as needed, though one resident reported occasionally refusing medication. However, the record review showed multiple instances where narcotic medications were signed out of the control records without corresponding documentation in the MAR, suggesting a lack of accurate reconciliation and documentation. The facility's own narcotic count sheets and audit records contained missing items, blank spaces, and incomplete tallies, further demonstrating a failure to maintain accurate and complete records as required by policy.