Failure to Encourage Oral Rinse After Steroid Inhaler Administration
Penalty
Summary
A deficiency was identified when a resident with multiple diagnoses, including emphysema, hypertension, viral hepatitis C, alcohol dependence, cocaine use, and toxic encephalopathy, was not encouraged or offered an oral rinse after receiving an inhaled medication containing a steroid (Symbicort). The resident, who was cognitively impaired and required moderate assistance with activities of daily living, had a physician's order for Symbicort to be administered twice daily for shortness of breath. During medication administration, observation revealed that the LPN administered the inhaled medication but did not instruct or encourage the resident to rinse his mouth afterward. Interviews with both the LPN and an RN confirmed that residents should rinse their mouths after using a steroid inhaler, and that this step was omitted for the resident in question. Review of the manufacturer's instructions for Symbicort also indicated that users should rinse their mouths with water and spit it out after inhalation. This failure to follow proper administration protocol was discovered during a complaint investigation and affected one of three residents reviewed for medication administration.