Failure to Protect Resident Privacy and Confidentiality of Medical Records
Penalty
Summary
The facility failed to maintain the privacy and confidentiality of personal and medical records for two residents. In the first instance, a medication aide (MA D) left a blister pack containing a resident's medical information at the side of the medication cart, with the information visible to anyone passing by in the hallway. The blister pack displayed the resident's name, medication details, prescription number, dosage, frequency, physician's order, diagnosis, and pharmacy name. The medication cart was left unattended while the aide administered medications in a resident's room, leaving the information exposed for several minutes. In the second instance, another medication aide (MA E) left a blister pack with a different resident's medical information on top of a medication cart parked in a hallway leading to the memory care unit. The cart was unattended, and the blister pack was visible to anyone in the hallway. The information on the blister pack included the resident's name, medication details, prescription number, dosage, frequency, physician's order, diagnosis, and pharmacy name. The aide acknowledged that the information should have been secured inside the cart before leaving it unattended. Both residents involved had significant medical histories, including chronic obstructive pulmonary disease and hypothyroidism, with one resident being cognitively intact and the other having severe cognitive impairment. The facility's staff, including the Director of Nursing, Assistant Director of Nursing, and Administrator, confirmed that personal and medical information should not be left exposed and must be kept confidential, as outlined in the facility's policy on resident rights, dignity, and privacy.