Failure to Provide Physician-Ordered Medications Due to Unavailability
Penalty
Summary
The facility failed to provide physician-ordered medications as prescribed for one of the sampled residents. Specifically, the facility did not have the medication Xifaxan, which is used to treat hepatic encephalopathy, available for administration to the resident on multiple occasions. The medication was not available in the facility from the pharmacy between the time the initial supply ran out and the refill was delivered, resulting in missed doses. Additionally, other medications such as lotilaner ophthalmic solution and midodrine were also not administered as ordered due to unavailability from the pharmacy. The resident involved had diagnoses including hepatic encephalopathy, hepatitis C, and hepatomegaly, and was cognitively intact at the time of the incident. Interviews with the resident and her representative revealed that the representative had brought in a supply of Xifaxan from the previous facility and left it with the nursing staff. Despite this, the medication was still not administered as ordered on certain dates, and there was no documentation that the provider group was notified when the medication was unavailable. Staff interviews confirmed that the resident's family provided a supply of Xifaxan and that the facility experienced delays in obtaining the medication from the pharmacy, partly due to insurance approval issues. Nursing staff were expected to notify the provider if a medication was unavailable, but there was no record of such notification for the missed doses. The medication administration records and nursing progress notes documented multiple missed doses of Xifaxan, lotilaner ophthalmic solution, and midodrine due to lack of availability.