Unlicensed Staff Administered Medication at RN's Direction
Penalty
Summary
A deficiency occurred when a registered nurse (RN) instructed a certified nursing assistant (CNA) to administer the medication Eliquis to a resident, despite facility policy and state regulations prohibiting CNAs from administering medications. The RN had already prepared the medication for the resident's evening dose but, after the resident refused to allow the RN into the room, handed the medication to the CNA who was delivering the resident's dinner tray. The RN remained at the doorway and observed as the CNA administered the medication. The resident involved was an adult male with multiple complex medical conditions, including chronic kidney failure, colostomy, sepsis, type 2 diabetes mellitus, abnormalities of gait and mobility, and rhabdomyolysis. The resident was cognitively intact and was care planned for anticoagulant therapy with Eliquis, which was ordered to be administered twice daily. The resident confirmed that on one occasion, a CNA had given him his Eliquis medication at the instruction of an RN. Interviews with the RN, CNA, and Director of Nursing (DON) confirmed that the CNA was not authorized or trained to administer medications and that this action was outside the CNA's scope of practice. The facility's policy clearly stated that only licensed nurses or other legally authorized staff could administer medications. The DON was not informed of the incident at the time it occurred. Both the RN and CNA acknowledged that the CNA should not have administered the medication.