Failure to Provide and Administer Prescribed Medication for Wound Care
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident's prescribed medication, triamcinolone acetonide cream, was available and administered as ordered. The resident, who had multiple diagnoses including type 2 diabetes mellitus, a non-pressure chronic ulcer of the right lower leg, and cellulitis, had a physician's order for daily application of triamcinolone cream to the right lower extremity for wound care. On review, it was found that the cream was not in stock, and a registered nurse substituted an antifungal cream (miconazole nitrate) instead, which was not appropriate for the resident's condition. The nurse could not recall the last time the prescribed cream was used and confirmed that the antifungal cream was not the same as the ordered medication. Further investigation revealed that the last order for the triamcinolone cream was placed several months prior, and the medication had not been reordered since. The Director of Nursing confirmed that the triamcinolone cream should have been reordered through the pharmacy and that the antifungal cream was not an appropriate substitute. Documentation indicated that the cream was being applied daily, despite its unavailability. Facility policy requires that medications be administered as ordered by the physician and in accordance with professional standards, including verifying the right drug before administration.