Medication Administration and Narcotic Reconciliation Deficiencies
Penalty
Summary
The facility failed to ensure the accurate administration of medications for four residents, as well as consistent reconciliation of narcotic medications. Surveyors observed that medications for several residents were not administered within the timeframes specified by physician orders and facility policy. For example, one resident with diagnoses including congestive heart failure and chronic pain received furosemide at times significantly later than the ordered administration times, with documentation showing doses given hours after the scheduled times. Another resident with chronic respiratory failure and dependence on a ventilator received multiple medications, all scheduled for early morning administration, several hours late. Similar late administration was observed for two additional residents, both with complex medical histories and scheduled medication times that were not adhered to by nursing staff. Interviews with staff revealed that the nurse responsible for administering morning medications typically began the process after the scheduled time and completed it several hours later, often due to responding to ventilator alarms and other duties. The Director of Nursing confirmed that nurses were allowed up to two hours after the scheduled administration time to give medications, but the observed delays exceeded this window. Residents and staff interviews corroborated that medications were frequently administered outside of the prescribed timeframes, contrary to facility policy and physician orders. Additionally, the facility did not consistently complete required controlled substance counts at shift changes. Review of the Controlled Substance Record Books for multiple wings showed numerous missing signatures for various shifts over a period of several weeks, indicating that narcotic counts were not being verified and documented as required. Staff interviews confirmed that both the outgoing and incoming nurses were responsible for this process, and that it should occur at every shift change. Despite prior education on this requirement, documentation showed ongoing noncompliance with controlled substance reconciliation.