Failure to Administer and Document Medications Within Required Time Frames
Penalty
Summary
The deficiency involves the facility’s failure to ensure that medication administration and documentation met professional standards and followed facility policy. During a survey, one LPN reported being a new graduate of one month and assigned to 44 residents. She stated that by 8:52 a.m. she had already given 9 a.m. medications to 40 residents since 8 a.m., and observation of one resident’s 9 a.m. medication pass took 22 minutes, including time spent locating a scheduled medication and waiting for the resident to get dressed and use the bathroom before obtaining blood pressure and administering medications. Based on the time required for this observed pass, the surveyor concluded that 9 a.m. medications were likely administered before 8 a.m., outside the regulatory time frame. The facility census at that time was 158 residents, and the cited deficiency involved 14 residents in the sample. Additional observations showed that multiple nurses did not document medication administration at the time medications were given, contrary to the facility’s medication administration policy dated 10/25/14. One RN assigned to 26 residents stated that all but one resident had received 9 a.m. medications and that she had started passing them around 7:30 a.m., but seven residents on the EMAR were highlighted red and marked late; she acknowledged that these residents had received their medications but had not been documented immediately after administration. Another LPN assigned to 31 residents stated that all but one resident in therapy had received their 9 a.m. medications, yet five residents remained highlighted green and marked due on the EMAR; the nurse stated she still needed to sign for the medications. A further RN stated that all her assigned residents had received 9 a.m. medications, but two residents remained highlighted green and marked due on the EMAR and were identified as assigned to another nurse on a split assignment. The facility’s policy requires medications for the immediate administration time to be prepared no more than 60 minutes in advance and that the individual administering the medication record administration on the MAR directly after the medication is given and review the MAR at the end of each pass to ensure all doses are administered and documented.
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