Failure to Provide Timely Pharmaceutical Services and Documentation
Penalty
Summary
The facility failed to provide pharmaceutical services in accordance with professional standards by not ensuring that two prescribed medications, Breo Ellipta Aerosol and Triamcinolone topical cream, were obtained and administered in a timely manner for one resident. The resident, who had a diagnosis of chronic obstructive pulmonary disease (COPD), had physician's orders for both medications, but multiple doses were not administered over several days. The electronic medication administration record (EMAR) showed that the medications were repeatedly marked as not available, with documentation indicating follow-up with the pharmacy, but there was no evidence that the pharmacy or physician was consistently contacted as required. Progress notes documented by an LPN indicated intentions to follow up with the pharmacy when the medications were unavailable, but there was a lack of documentation confirming that the pharmacy or physician was actually contacted. The LPN stated during interview that she would call the pharmacy and physician if medications were out of stock for more than three days, but could not provide evidence of these communications in the progress notes. Additionally, the LPN acknowledged that there were no backup medications available in the facility for inhalers or steroid creams, and that they had to wait for the pharmacy to deliver the medications. The Director of Nursing (DON) confirmed that while some backup medications were available in the facility, there were no backup inhalers or steroid creams. The DON stated that nurses should call the physician for follow-up orders or alternative medications when a medication is not available, and that all such actions should be documented in the progress notes. Upon review, the DON acknowledged that there was insufficient documentation of pharmacy and physician notification, and that continued documentation of medication unavailability without further action was not appropriate. The facility's policy required medications to be administered in a safe and timely manner as prescribed.