Failure to Follow Infection Control Practices During Medication Administration
Penalty
Summary
During a medication administration observation, a registered nurse was seen removing medications from a medication card by punching them directly into his ungloved hand before placing them into a medication cup. This process was repeated for a second medication. The nurse acknowledged during an interview that medications should not be handled with bare hands and should be transferred directly into the medication cup. Further observation revealed that when the nurse attempted to punch a medication into the cup, the pill missed and landed on the medication cart. The nurse then picked up the medication from the cart surface with his ungloved fingers and placed it into the medication cup. The resident involved had multiple diagnoses, including COPD, hemiplegia, bipolar disorder, and depression, and required supervision for several activities of daily living. These actions were not in accordance with CDC standard precautions for infection control and medication safety.