Failure to Administer Ordered Medication for Suspected Scabies
Penalty
Summary
A deficiency occurred when the facility failed to administer permethrin external cream as ordered for a resident who was suspected of having scabies. The resident had been admitted and readmitted with multiple diagnoses, including gastrostomy, ADHD, and gastro-esophageal reflux disease. Physician orders were in place for contact isolation, monitoring of skin rashes, and the application of permethrin cream from the neck down to the toes for prophylactic treatment. The order specified that the cream should be applied in the evening, left on for 12 hours, and then washed off in the morning. On the scheduled date for the second application of permethrin cream, the Medication Administration Record (MAR) indicated that the medication was not found and had to be reordered. The nurse involved confirmed that the cream was unavailable at the time and that she reordered it. The Director of Nursing (DON) reviewed the records and confirmed that while the first dose had been administered, the second dose was not given because the medication was not available. The DON also stated that the medication was delivered after the resident had already been discharged home, and the resident did not receive the second treatment as ordered. Facility policy requires that medications be administered as prescribed and within a specified time frame. In this case, the failure to have the medication available and to administer it as ordered resulted in the resident not completing the prescribed treatment regimen. The deficiency was identified through interviews, record reviews, and a review of facility policy, which confirmed that the medication administration did not align with physician orders or facility guidelines.