Failure to Honor Resident's Right to Refuse Medication
Penalty
Summary
A deficiency occurred when facility staff failed to respect a resident's right to refuse medication. The resident, who had intact cognition and a medical history including anxiety disorder, conversion disorder, rheumatoid arthritis, and depression, was on a bowel protocol due to concerns about constipation. Despite the resident reporting to the nurse that they had already had a bowel movement earlier in the day and refusing the suppository, the nurse continued to attempt administration and ultimately gave the medication with the resident's nighttime medications after repeated requests. Documentation showed that the resident had a large and a medium bowel movement on the day in question, which was not recognized by the nurse at the time of medication administration. The nurse stated he was unaware of any documentation of the resident's bowel movements and relied on a printed list indicating the resident had not had a bowel movement in three days. The nurse did not verify the resident's report by checking the electronic health record or consulting with the assigned CNA, as outlined in facility policy and as described by supervisory staff during interviews. Interviews with supervisory staff, including the LPN Supervisor, ADON, Quality Assurance nurse, DON, and Administrator, confirmed that the expected protocol was to verify a resident's report of a bowel movement by reviewing documentation and consulting with staff before proceeding with further interventions. In this case, the nurse did not follow these steps, resulting in the administration of a suppository against the resident's expressed wishes and without proper verification, thereby failing to honor the resident's right to self-determination and choice.