Inaccurate MAR Documentation for Constipation Medication
Penalty
Summary
The deficiency involves the facility’s failure to accurately document the administration and refusals of Linzess, a medication for chronic constipation, for one resident. A physician’s order dated 04/16/25 directed that Linzess 290 mcg be given orally once daily on Sunday through Friday. Review of the Medication Administration Records (MARs) for November, December, and January showed multiple entries by several nurses and medication aides indicating that the resident received single capsules of Linzess on numerous dates. However, during interviews, Nurse #1, Medication Aide #1, Medication Aide #2, and Nurse #4 each admitted they had documented that the medication was administered on Sundays, Mondays, Wednesdays, and Thursdays when it was not actually given and was instead left or stored in the resident’s room. Nurse #4 further stated that, for as long as she could remember, the resident had actually been taking three capsules of Linzess only on Tuesdays and Fridays, not daily as ordered. The Nurse Practitioner reported that she relied on the MAR documentation to determine whether medication changes were needed and expected accurate documentation at all times. The Consulting Pharmacist stated she would have expected staff to accurately document refusals of the daily Linzess dose and emphasized that the MAR is used to make clinical decisions and that accurate refusal documentation could have supported earlier intervention, such as a medication change. The DON also stated that nursing staff should have accurately documented refusals of Linzess and that the MAR is an important clinical tool that must be accurate at all times.
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