Failure to Administer and Document Medications as Ordered for Two Residents
Penalty
Summary
The facility failed to ensure medications were administered as ordered by the physician for two residents. One resident with chronic respiratory failure, tracheostomy, liver transplant, G-tube, seizures, and other conditions reported around midday that he had not received his morning medications, stating the nurse had told him they would be given with his noon medications, but as of after 12:30 p.m. he still had not received them. The LPN responsible stated she was running late and had not had a chance to administer the morning medications, acknowledging they should be given within one hour before or after the scheduled start time and that she would notify the nurse practitioner of the late administration. The nurse practitioner stated that this resident’s medications, including continuous Nepro tube feeding, Keppra, metoprolol, and tacrolimus, should be administered as ordered and that administering both morning and noon medications together could cause gastrointestinal upset, loose stools, and abnormal medications. The resident’s care plan directed staff to administer medications as ordered, and the facility’s medication administration policy required medications to be given in accordance with prescriber orders and within 60 minutes of the scheduled time. For a second resident with multiple diagnoses including chronic respiratory failure with hypoxia, tracheostomy and ventilator dependence, gastrostomy, left femur fracture, hypertension, seizures, anxiety disorder, depressive disorders, generalized edema, hip pain, diaphragmatic hernia, and delirium, there were concerns regarding documentation of medication administration. This resident had orders for ferrous sulfate in the morning, valproic acid oral solution twice daily, and clonazepam three times daily, with a care plan to give medications as ordered. Around midday, the resident was in bed and stated he was unsure if he had received his medications, although he usually did. The LPN assigned to this resident later stated she was supposed to sign off medications immediately after administering them and could not explain why she had not documented administration when she reported giving the medications at 9:00 a.m. This conflicted with the facility’s policy requiring proper and timely documentation of medication administration.
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