Failure to Adjust Medication and Supplement Administration for Dialysis Schedule
Penalty
Summary
The facility failed to provide care and services in accordance with professional standards for a resident requiring dialysis by not adjusting medication administration times, nourishment supplementation, and monitoring to accommodate the resident's scheduled dialysis sessions. The resident, who had multiple diagnoses including end stage renal disease (ESRD), diabetes, heart failure, and was dependent on hemodialysis, had medication and supplement orders that conflicted with the times the resident was out of the facility for dialysis. Despite the resident's dialysis schedule being known (Tuesday, Thursday, and Saturday afternoons), there were no physician orders specifying alternative administration times for these days, and medications and supplements were repeatedly not administered as ordered on at least nine dialysis days during the resident's stay. Review of the electronic medication administration record (EMAR) and nursing progress notes revealed that medications such as Hydralazine, Novolog, Coreg, Gabapentin, Prosource, and Nepro, as well as blood glucose monitoring, were not given at scheduled times because the resident was out of the facility for dialysis. Documentation codes and nursing notes indicated the reason for missed doses was the resident's absence for dialysis, but there was no evidence that the physician was notified or that orders were adjusted to accommodate the dialysis schedule. The facility's own policies required that medication administration times be determined by resident need and benefit, and that staff be educated on timing and administration of medications, particularly before and after dialysis. Interviews with nursing staff, the unit manager, the DON, and the administrator confirmed that nurses were expected to review and adjust medication orders with the physician for residents attending dialysis, and that documentation should not simply state that medications were missed due to dialysis. The DON acknowledged that the physician should have been notified to obtain appropriate orders and that the EMAR should not reflect missed medications for scheduled dialysis absences. The deficiency was identified through review of records, interviews, and facility policy, and was specific to one resident reviewed for dialysis services.