Failure to Honor Resident's Right to Refuse Medication
Penalty
Summary
A deficiency occurred when a nurse crushed a resident's prescribed medications and mixed them into the resident's food without the resident's knowledge after the resident had refused to take the medications. The resident, who has diagnoses including generalized anxiety disorder, auditory hallucinations, catatonic disorder, noncompliance with medical treatment, and paranoid schizophrenia, was alert and oriented at the time and reported noticing the altered taste and presence of crushed pills in the food. The resident did not report the incident to facility staff but did inform their guardian and the police. The nurse later admitted to the action, stating it was done after the resident refused the medication and that the intent was to ensure the resident received the prescribed treatment. Facility staff interviews confirmed that the practice of hiding medication in food without the resident's awareness is not standard procedure and is not taught or permitted by facility policy. The nurse involved acknowledged that the resident should always be aware of what medications they are taking and that the correct procedure after a refusal is to offer the medication again later, not to conceal it in food. Documentation showed that the resident had a history of refusing medications and that, on a previous occasion, the guardian had given one-time consent for medication to be mixed with food, but there was no ongoing order or consent for this practice. Facility records, including care plans and medication administration records, indicated that the resident was intermittently noncompliant with medication but did not display behaviors that would justify covert administration. The facility's medication pass policy requires that medications be crushed and administered separately with the resident's knowledge, and there was no policy allowing for medications to be hidden in food following a refusal. The administrator and DON confirmed that staff are expected to respect residents' rights to refuse medication and that the incident was not documented as a medication administration in the resident's record because it was unclear how much of the medication was actually consumed.