Lack of Parameters for PRN Opioid and Diuretic Administration
Penalty
Summary
The facility failed to ensure that each resident’s drug regimen was free from unnecessary drugs by not obtaining specific parameters for as needed (PRN) administration of opioid and diuretic medications. For one resident with multiple diagnoses including chronic pain, polyneuropathy, and edema, physician orders for PRN oxycodone and bumetanide lacked clear guidelines regarding the level or type of pain, the number of tablets to administer, or specific criteria for edema. The resident’s medical record showed frequent use of PRN pain medication and diuretics, with medication administration records indicating variable dosing and frequency without documented parameters. Staff interviews confirmed that the resident often determined the dose of oxycodone to take and requested PRN bumetanide as needed, with no specific instructions from the physician regarding administration criteria. The facility’s policy required medications to be administered only as prescribed and in a safe and effective manner, but the orders for PRN medications did not provide sufficient detail to guide staff in their administration. Observations and interviews revealed that staff relied on the resident’s requests and their own judgment rather than clear physician instructions, resulting in inconsistent medication administration. The lack of specific parameters for PRN opioid and diuretic use constituted a failure to ensure the resident’s drug regimen was free from unnecessary drugs, as required by regulation.