Failure to Assess and Authorize Resident Self-Administration of Medications at Bedside
Penalty
Summary
The facility failed to ensure the interdisciplinary team determined residents' ability to safely self-administer medications, as required by policy, before medications or supplements were kept at the bedside. Facility policy on self-medication required identification of appropriate residents, a provider order, completion of a self-medication administration record, and use of a pharmacy-filled pill holder stored in a locked cart or locked resident drawer. For one resident with acute and chronic respiratory failure and aspergillosis, who had intact cognition and required set-up to moderate assistance with activities of daily living, surveyors observed a prescribed ipratropium bromide nasal spray on the overbed table on multiple occasions without licensed staff present. There was no documented provider order for self-medication administration and no self-medication assessment, even though the medication administration record showed the nasal spray was ordered and being administered by nursing staff at scheduled times. An LPN and the RN Unit Manager both confirmed that residents should not have medications at the bedside without an assessment and provider order, and acknowledged that this resident did not have such an order and that the nasal spray should have been kept in the locked medication cart. For another resident with heart disease, syncope, collapse, moderate cognitive impairment, and one-sided upper extremity mobility impairment, surveyors observed elderberry supplements on the bedside table on two separate days. The resident’s prior order for an elderberry zinc/vitamin C/immune lozenge had been discontinued months earlier, and a nurse practitioner note documented discontinuation of multiple vitamins and elderberry tablets due to polypharmacy. There was no current provider order for elderberry supplements, no order for self-medication administration, and no comprehensive care plan addressing the ability to self-administer medications. An LPN stated the resident was not taking any supplements and had no self-administration orders, confirmed the presence of elderberry supplements at the bedside, and stated the resident should not possess medications that were not ordered. The resident reported taking the elderberry supplements daily since admission, brought in by a family member. The DON stated residents should not have medications at the bedside without a provider order and proof they could take them safely, and confirmed that both the elderberry supplements and nasal spray were medications that should not have been at the bedside without an order and assessment.
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