Failure to Properly Dispose and Document Medications
Penalty
Summary
The facility failed to provide proper pharmaceutical services for two residents, resulting in deficiencies related to medication administration and disposal. For one resident with severe dementia and on hospice care, morning medications including Depakote, fluoxetine, lisinopril, Provera, and lorazepam were prepared and mixed with pudding, but the resident refused to take them. The medication aide placed the cup with the mixed medications, labeled with the resident's name, in the medication cart instead of disposing of them as required. The aide believed it was acceptable to keep the medications as long as the cup was labeled, and this misunderstanding was confirmed during interviews. The licensed vocational nurse was informed of the refusal but did not ensure the medications were properly wasted, which is necessary to prevent medication errors. In another case, a resident with multiple diagnoses including epilepsy and schizophrenia was prescribed hydrocodone-acetaminophen for pain management. The nurse signed out a dose of hydrocodone on the narcotic record but did not administer it, instead discarding it in the sharps container without a witness or proper documentation. The nurse admitted to not following the required procedure for wasting controlled substances, which includes having another nurse witness the disposal and documenting it with double signatures. The Director of Nursing confirmed that the narcotic record did not accurately reflect the time the medication was pulled and that the medication was not administered as documented. Facility policy requires that medications be administered and disposed of according to professional standards, including proper identification, documentation, and witnessing of controlled substance disposal. The observed failures to follow these procedures for both regular and controlled medications led to the deficiencies cited in the report.