Topical Medication Applied Without Physician Order
Penalty
Summary
The facility failed to obtain a physician's order prior to the application of a topical medication for a resident with severe cognitive impairment and high risk for pressure ulcers. During an observation, a Certified Nurse Assistant and a Restorative Nurse Assistant identified bloody drainage, redness, and small skin tears in the resident's buttock skin folds and notified the Licensed Vocational Nurse (LVN). The LVN assessed the area, identified new Moisture Associated Skin Damage (MASD) with bloody discharge, cleansed the area with normal saline solution, and applied zinc oxide ointment without a physician's order. The LVN stated it was common practice to follow the skin treatment protocol by cleansing and applying zinc oxide ointment before reporting the condition to the physician. Review of facility policies and procedures confirmed that the application of zinc oxide ointment requires a physician's order and that medications should only be administered upon a clear, complete, and signed order from an authorized prescriber. The Director of Nursing and Director of Staff Development both confirmed that the facility's protocols do not allow for the application of topical agents such as zinc oxide without a physician's order. This practice was not in accordance with professional standards or the facility's own policies.