Failure to Remove Topical Pain Patch per Physician's Order
Penalty
Summary
A deficiency occurred when nursing staff failed to remove a topical lidocaine pain patch from a resident in accordance with the physician's order. The resident, who was alert and oriented, had a physician's order for lidocaine 4% patches to be applied to the shoulders and chest once daily and removed per schedule, with no order for self-administration. Observations revealed that the resident had three lidocaine patches on her body, dated from the previous day, and she reported that while the nurse applied the patches in the morning, she removed them herself whenever she chose. Documentation showed that the patches were applied as ordered, but removal was not consistently performed by nursing staff as required. Nurse interviews confirmed that on at least one occasion, a nurse allowed the resident to remove the patches herself and did not verify their removal. Another nurse observed that patches from the previous day were still present when applying new ones but did not notify the unit manager on that day. The unit manager did not recall being notified about the issue, and the DON stated that the nurse should have removed the patches herself according to the physician's order. The NP confirmed that the order specified a removal time for a reason and that the nurse should have followed the order.