Failure to Administer Physician-Ordered Nicotine Patch
Penalty
Summary
The facility failed to follow a physician's order for the administration of a nicotine patch for a resident admitted with diagnoses including tobacco use and generalized muscle weakness. The physician's order specified that a 14mg nicotine patch should be applied transdermally once daily for six weeks as part of a smoking cessation plan. During medication administration, the assigned LVN reported that the nicotine patch was not available and did not administer the medication as ordered. The LVN also acknowledged that the physician should be notified when a medication is unavailable and recognized the potential for withdrawal or side effects if the patch was not given. Further investigation revealed that the nicotine patch was actually available as a house supply in the medication room, and the DON confirmed it should have been administered. The facility's policy on administering medications requires that medications be given safely, timely, and in accordance with prescriber orders, including any required timeframe. The failure to administer the nicotine patch as ordered constituted a lapse in following professional standards of clinical practice and facility policy.