Failure to Follow Self-Administration Assessment Limits for Topical Medications
Penalty
Summary
The deficiency involves the facility’s failure to ensure the interdisciplinary team assessed and determined clinical appropriateness for self-administration of medications in accordance with its policy for one resident. The facility’s policy required that if a resident desired to self-administer medications, the interdisciplinary team would assess the resident’s cognitive, physical, and visual abilities and document the results on a Self-Administration Assessment form in the medical record. The resident in question had diagnoses including COPD, primary insomnia, depression, and nicotine dependence, and a BIMS score of 15 indicating intact cognition. The resident’s care plan documented a physician’s order for unsupervised self-administration of carboxymethylcellulose eye drops only, and the Self-Administration of Medication assessment form indicated the resident was fully capable to self-administer eye drops, but topical medications (including patches) were not selected as medications the resident was capable of self-administering. There were no physician’s orders allowing the resident to store medications at the bedside. Despite this, surveyor observations and interviews showed that multiple topical medications were present and left unattended in the resident’s room and bathroom, and the resident reported self-administering them. Diclofenac arthritis cream was observed on the bedside table, and later Diclofenac arthritis cream, Nystatin cream, and Hydrocortisone cream were observed on a table next to the resident’s toilet. The resident stated she administered the creams herself and that a nurse had given her the cream in a medicine cup, although she could not recall which nurse. The ADON confirmed during the survey that these topical medications should not have been left unattended in the resident’s bathroom and that, per the self-administration assessment, the resident was only allowed to self-administer eye drops and not topical creams. This discrepancy between the documented assessment/physician orders and the actual practice of allowing the resident to self-administer and keep topical medications in the room led to the cited deficiency.
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