Failure to Administer and Manage Pain Medications per Physician Orders
Penalty
Summary
The deficiency involves the facility’s failure to provide pharmaceutical services in accordance with physician orders for one resident with multiple right rib fractures, a lumbar wedge compression fracture, and a history of falls. The resident was cognitively intact and required moderate assistance with several ADLs. Physician orders on admission included methocarbamol 500 mg PO three times daily for muscle spasm, gabapentin 100 mg PO three times daily for neuropathy, and a lidocaine 4% patch applied topically to the right chest area once daily for pain management with removal per schedule. Medication Administration Record (MAR) audit data showed that on one date, the 9 a.m. doses of methocarbamol and gabapentin were not administered until 12:07 p.m., and the 1 p.m. doses were not administered until 2:42 p.m., outside the facility’s stated one-hour before/after administration window. The LVN who passed these medications acknowledged being late with the medication pass and confirmed that some medications were given outside the time frame, resulting in the two scheduled doses of both methocarbamol and gabapentin being administered too close together. The DON confirmed that these administration times were not timely per the physician’s orders and that the doses were administered too close together. The facility also failed to ensure proper management of the resident’s lidocaine 4% patch. One LVN reported finding an old lidocaine patch still in place on the resident’s lower lumbar area that should have been removed by the prior 3 p.m.–11 p.m. shift nurse, and documented that the resident was upset and refused a new patch. The DON stated the patch was supposed to be removed daily at 9 p.m. by the evening shift and referenced hospital discharge instructions indicating the patch should be removed after 8–12 hours. Additionally, hospital discharge instructions directed application of one lidocaine 4% patch to the affected area twice daily for seven days, but the admitting RN carried over the order as once daily and could not recall how the order was verified with the physician. The primary care physician later stated he did not change the lidocaine patch frequency from twice daily to once daily and that the facility should have followed the hospital discharge instructions.
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