Failure to Administer Medications Within Ordered Time Frames
Penalty
Summary
The deficiency involves the facility’s failure to administer medications in accordance with physician orders and facility policy for two residents. One resident, cognitively intact with a BIMS score of 15 and diagnoses including orthostatic hypotension, end-stage renal disease, and polyosteoarthritis, reported not receiving scheduled morning medications at 6:00 AM on one day, instead receiving them at 8:00 AM, and also reported not receiving Eliquis, a multivitamin, and Midodrine on a prior date. Record review showed that Midodrine 10 mg ordered every eight hours with a 10:00 PM scheduled dose was not documented as administered until 5:19 AM the following day, more than seven hours late. The same resident’s Medication Administration Audit Report showed that on another day, Midodrine, Protonix, and Ferrous Sulfate ordered for 6:00 AM were documented as administered at approximately 8:00 AM. Nursing staff interviews revealed inconsistencies and issues related to medication availability and administration timing. One RN who worked the night shift denied giving Midodrine late and suggested that medications might not be administered if they were unavailable or not ordered. Another RN assigned to the resident on the evening shift documented that Midodrine was “on order” and stated it was not administered because the resident’s blood pressure was high, although there was no documentation of blood pressure readings in the progress notes for that date other than a single reading at 6:17 AM of 110/68. The facility’s blood pressure summary for that resident showed no additional readings for that day, and the progress note documented the Midodrine as on order without further clarification. A second resident, with diagnoses including cerebrovascular disease and essential hypertension and a BIMS score of 6 indicating cognitive impairment, also received medications outside the facility’s required time frame. During a medication pass observation, an LPN reported being alone to pass medications to 39 residents and stated she was not finished with the 9:00 AM medications. The LPN took this resident’s blood pressure at 11:14 AM and then prepared and administered the resident’s 9:00 AM medications (Aspirin, Amlodipine, and Vitamin D3) between 11:16 AM and 11:21 AM. The Medication Administration Audit Report showed these medications, ordered for 9:00 AM, were documented as administered at 11:18 AM, more than two hours late. The DON stated that medications are to be administered within one hour before or after the scheduled time and that nurses are expected to follow physician orders and facility policy, which requires medications to be given within 60 minutes of the scheduled time.
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