Failure to Assess and Authorize Resident Self-Administration of Medication
Penalty
Summary
The deficiency involves the facility’s failure to follow its own policy requiring assessment and authorization before allowing residents to self-administer medications. The facility’s Self-Administration of Medications policy states that residents have the right to self-administer medications only if the interdisciplinary team determines it is clinically appropriate and safe, based on an assessment of the resident’s mental and physical abilities, including understanding of labels, purpose, dosage, timing, administration, and recognition of risks. The policy further requires completion of a Self Administration of Medications assessment form and a signed consent form, and specifies that medications for self-administration must be stored in a locked cabinet in the resident’s room, not accessible to other residents, with the resident responsible for reporting each dose used to nursing staff. Resident #1 was admitted with diagnoses including encephalopathy (unspecified), Parkinsonism (unspecified), essential tremor, COPD (unspecified), and shortness of breath, and had a BIMS score of 12 indicating cognitive intactness. Physician’s orders included Flonase (fluticasone propionate nasal spray) to be administered as one inhalation in both nostrils twice daily. On multiple observations over two days, surveyors noted a bottle of fluticasone on top of a dresser at the foot of the resident’s bed, rather than secured in a locked cabinet. The resident reported that she self-administered the fluticasone and that staff brought her a new bottle when needed. The DON confirmed the presence of the fluticasone bottle in the room, and the corporate RN confirmed that there was no physician order for self-administration and no completed self-administration assessment for this resident, despite the resident self-administering the medication and keeping it at bedside.
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