Unlicensed Individuals Administered Medications Without Nurse Supervision
Penalty
Summary
Licensed nurses at the facility failed to administer medications as required, instead allowing an unlicensed private caregiver and the resident's Power of Attorney (POA) to administer medications on multiple occasions. The resident in question was documented as moderately cognitively impaired and completely dependent on staff for all activities of daily living, including eating, oral hygiene, toileting, showering, dressing, bed mobility, and transfers. The resident had multiple physician orders for daily and scheduled medications, including antibiotics, supplements, and medications for chronic conditions. Despite these needs, observations and interviews revealed that the private caregiver, who was not a licensed nurse and had no formal training in medication administration, was routinely given the resident's medications by nursing staff to administer without supervision. The private caregiver reported that nurses told her and other caregivers they did not have time to wait for the resident to take her medications, as she was a slow swallower. The caregiver described daily practices of mixing and administering medications, including thickening liquids and crushing pills, without knowledge of proper dosages, side effects, or potential interactions. The nurse confirmed that she prepared the medications and provided them to the POA or private caregivers for administration, stating that this was a common practice among staff and approved by facility administration. The Interim Director of Nursing (DON) also acknowledged giving approval for the POA and private caregivers to administer medications without a nurse present, despite their lack of licensure or training. Facility policy required that licensed nurses administer medications, remain with the resident until the medication is swallowed, and not leave medications in the resident's room without orders. The policy also specified that medications must be administered by legally authorized and trained persons in accordance with applicable laws and standards of practice. However, observations showed that medications, thickener, and pill crushers were left in the resident's room, and the private caregivers continued to administer medications daily, contrary to facility policy and regulatory requirements.