Failure to Secure Medications and Adhere to Self-Administration Protocols
Penalty
Summary
Surveyors identified that medications and biologicals were not properly secured in accordance with professional standards, as required by facility policy and federal regulations. Specifically, medications were left unattended at the bedsides of four residents without appropriate physician orders for self-administration, and in some cases, while the residents were asleep. For example, one resident with mild cognitive impairment, COPD, and congestive heart failure was found sleeping with a cup of medications left on the bedside table, and there was no physician order permitting self-administration. The LPN responsible stated she left the medications because the resident was asleep and intended to return, but acknowledged this was not standard practice without a self-administration order. Another resident with diabetes, asthma, and anxiety had a physician order to self-administer certain medications, but a pill not matching the approved list was found at the bedside while the resident was asleep. The LPN explained she left the medication because of the self-administration order, but the medication present was not authorized for bedside self-administration. Two additional residents, one with end stage renal disease and macular degeneration and another with osteomyelitis, diabetes, anxiety, and opioid dependence, were also found with medication cups at their bedsides containing unidentified tablets. Neither had current physician orders or care plan documentation permitting self-administration, yet the LPN stated she believed they had such orders. Interviews with nursing staff and the DON confirmed that medications should not be left at the bedside without a physician order for self-administration, and never if the resident is asleep. The facility's own policy requires a physician's order for all self-administered medications, and the DON acknowledged that the policy was not followed in these instances. The deficiency was based on direct observations, record reviews, and staff interviews, all indicating a failure to properly secure medications and adhere to established protocols.