Improper Medication Administration and Scope of Practice Violation
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) crushed all of a resident's morning medications, mixed them with oatmeal, and left them at the resident's bedside. The resident, who had a history of myocardial infarction, atrial fibrillation, chronic systolic heart failure, and hypertension, was cognitively intact and had no documented swallowing difficulties. According to interviews and record review, the resident typically took medications whole with water and had not requested for them to be crushed. The LVN did not obtain a physician's order before crushing the medications, which included several that should not be crushed, such as enteric-coated aspirin, isosorbide mononitrate extended-release, and pantoprazole delayed-release tablets. A certified nursing assistant (CNA) subsequently administered the oatmeal mixed with crushed medications to the resident, despite this being outside the CNA's scope of practice. The CNA confirmed that she assisted the resident with breakfast and provided the oatmeal with medications after the LVN left the room. The resident noticed the altered taste and reported the issue to a family member, who also confirmed that the CNA had given the medication-laced oatmeal. Facility policy states that only licensed nurses are to administer medications and that a physician's order is required to crush medications. Interviews with staff, including the director of staff development and the director of nursing, confirmed that the CNA should not have administered medications and that the LVN misinterpreted the resident's needs. The facility's own policies and in-service training materials reinforce that medication administration is the responsibility of licensed nurses and that CNAs are not permitted to give medications to residents.