Failure to Obtain Nurse Assessment and Authorization for PRN Narcotic Administration
Penalty
Summary
A deficiency occurred when a resident with diagnoses including fibromyalgia, depression, and pain received as needed (PRN) narcotic pain medication, specifically oxycodone with acetaminophen, without the required assessment and authorization from a licensed nurse. The clinical record review showed that a Qualified Medication Aide (QMA) administered the PRN narcotic pain medication on multiple occasions, but there was no documentation of a licensed nurse assessment or co-signature on the controlled drug record for these administrations. Facility policy and the QMA Scope of Practice require that a licensed nurse assess the resident's need for PRN narcotic pain medication, provide authorization, and co-sign the medication administration record. Interviews confirmed that QMAs are expected to obtain permission from a licensed nurse and document this in the resident's record, including the nurse's co-signature by the end of the shift. However, these steps were not followed, as evidenced by the lack of assessment and authorization documentation for the resident who received the PRN narcotic pain medication.