Failure to Administer Metformin as Ordered with Meals
Penalty
Summary
A deficiency was identified when a resident with Type 2 Diabetes Mellitus, hypoglycemia, and Post-Traumatic Stress Disorder was not administered Metformin as ordered by the physician. The physician's order specified that Metformin 500 mg should be given by mouth with meals for diabetes management. However, during a medication administration observation, an LPN crushed the Metformin tablet, mixed it with pudding, and administered it to the resident before the scheduled breakfast meal, contrary to the order to give the medication with meals. Interviews with nursing staff revealed a misunderstanding or disregard for the physician's order. The LPN who administered the medication stated that he typically gives medications one hour before or after the scheduled time and that the resident preferred taking medication with pudding. He also indicated that he would not contact the physician if a resident refused a meal but would still administer Metformin, even if the resident did not eat. Other LPNs and the DON confirmed that a spoonful of pudding or applesauce is not considered a meal and that medications ordered to be given with meals should be administered with or directly after a meal, not before. Review of the facility's policies and reference materials, including the Nursing Drug Handbook and Medlineplus.gov, confirmed that Metformin should be given with meals to decrease gastrointestinal upset. The facility's policies require accurate implementation of medication orders and administration as per the physician's instructions. The failure to administer Metformin with a meal, as ordered, was observed and confirmed through staff interviews and record review.