Failure to Instruct Resident to Rinse Mouth After Inhaled Corticosteroid Administration
Penalty
Summary
A deficiency occurred when a resident with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) was administered Symbicort, an inhaled corticosteroid, by an LPN who failed to instruct the resident to rinse his mouth after use. The resident was cognitively intact, as indicated by a BIMS score of 14, and had a physician's order for Symbicort to be administered twice daily. During a medication pass, the LPN administered the medication but did not provide water or instruct the resident to rinse and spit, as required by the manufacturer's instructions to reduce the risk of oral infections such as thrush. The facility's policy required medications to be administered in accordance with best practices, and the manufacturer's package insert specifically advised rinsing the mouth after inhalation. The DON confirmed that staff were expected to follow these instructions, although there was no specific facility policy for oral inhalers. The failure to instruct the resident to rinse his mouth was confirmed by both observation and staff interview.