Failure to Ensure Availability and Administration of Ordered Medications
Penalty
Summary
The deficiency involves the facility’s failure to provide pharmaceutical services and ensure ordered medications were available and administered as prescribed for multiple residents, contrary to facility policy requiring medications to be given in accordance with prescriber orders and within one hour of the prescribed time. For one resident with hypothyroidism and depression, physician orders included nightly doses of Zyprexa and Mirtazapine starting in early January, but the medication administration record (MAR) showed blank entries for two nights and a held dose on the third night, with nursing notes indicating the medications were still waiting to be delivered by the pharmacy after admission from the hospital. Another resident with hypertension, COPD, and a right above-the-knee amputation had an order for IV Meropenem every six hours for a wound, but the MAR documented a scheduled dose as not administered, with nursing notes stating the medication was not yet available from the pharmacy. A resident with bipolar disorder and diabetes had new orders for Lithium and Tizanidine; the MAR showed a bedtime Tizanidine dose not administered and a morning Lithium dose held, with progress notes documenting that the resident was a new admission and staff were waiting for the pharmacy to deliver the Tizanidine, and that the medical director was aware the Lithium was not given. A resident with hypertension and diabetes had multiple antidiabetic and mood-stabilizing medications ordered, including Glipizide, Dapagliflozin, Metformin, and Divalproex. The MAR documented several doses on the first days after admission as held or not administered, with nursing notes indicating the medications were on order or awaiting pharmacy delivery. Another resident with dementia and glaucoma had an ordered ophthalmic solution for glaucoma, but a scheduled dose was documented as not administered due to the medication being unavailable and on order. A resident with COPD and hypertension had an ordered Budesonide-Formoterol inhaler, but the first scheduled evening dose after admission was held, with nursing notes stating the medication was waiting for pharmacy delivery. In interviews, the Nursing Home Administrator initially stated that the facility’s Pyxis was well stocked and that residents would not be admitted without medications available, but later stated she would not necessarily expect medications to be available as ordered all the time and would inform the provider if a medication was not available.
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