Improper Handling of Oral Medications During Preparation and Administration
Penalty
Summary
The deficiency involves failure to maintain infection control standards during medication preparation and administration. For one resident with traumatic brain injury, type II diabetes, muscle weakness, depression, dysphagia, and moderately impaired cognition, an LPN prepared morning medications including Celexa and Vimpat. During preparation, the LPN dropped the Celexa tablet onto the top of the medication cart, where it bounced multiple times, then picked it up with a bare hand and placed it into the medication cup. The same process occurred with the Vimpat tablet, which was also dropped on the cart and then picked up with a bare hand and placed into the cup. After preparing all medications, the LPN handled the medication cart drawers and computer mouse, then picked up the medication cup and handed it to the resident, who ingested the pills with water. For a second resident with acute and chronic respiratory failure with hypoxia, type II diabetes, peripheral vascular disease, chronic kidney disease, hypertension, and moderately impaired cognition, the same LPN prepared multiple morning medications including Flomax, buspar, carvedilol, clopidogrel, ferrous sulfate, folic acid, lasix, levothyroxine, protonix, potassium chloride, and seroquel. The LPN dropped the Flomax tablet on the top of the medication cart, where it bounced and landed between the narcotic book and a tray holding water and medication supplies, then picked it up with a bare hand and placed it into the medication cup. The LPN then repeatedly punched each of the remaining medications from their cards into one bare hand before transferring them into the medication cup. After returning the punch cards to the cart drawer and using the computer mouse, the LPN carried the medication cup to the resident’s room and observed the resident take all pills with water. In an interview, the LPN confirmed touching the pills with bare hands, including the dropped Flomax, and stated that he usually punches residents’ pills into his bare hands because he drops them when attempting to punch them directly into the cup. Facility policy on medication administration stated that staff should take care not to touch medications with a bare hand when removing them from the source.
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