Failure to Administer Skin Treatments per Physician Orders
Penalty
Summary
The facility failed to ensure that skin treatments for a resident were completed according to physician orders. The resident, who had diagnoses including morbid obesity, psoriasis vulgaris, seborrheic dermatitis, and Type I diabetes mellitus, was at risk for chronic cellulitis and skin breakdown. Physician orders required the application of ketoconazole cream, miconazole powder, and triamcinolone cream at specific intervals. Review of the Treatment Administration Record (TAR) indicated these treatments were documented as administered as ordered. However, interviews revealed that the resident was self-administering her skin treatments and had been out of the prescribed treatments for three days, despite informing nursing staff. The treatments were kept at the resident's bedside without an order permitting self-administration or bedside storage. The LPN/Unit Manager confirmed that the treatments were not available in the medication cart and had not been available for some time, yet staff continued to sign off on the TAR as if the treatments had been given. Facility policy required medications to be administered in accordance with physician orders, which was not followed in this case.