Late and Inaccurate Medication Administration for a Resident
Penalty
Summary
Surveyors identified a deficiency in medication administration for Resident 4 related to failure to follow physician orders, late administration of scheduled medications, and inaccurate documentation on the Medication Administration Record (MAR). Resident 4 was admitted with diagnoses including COPD, type 2 diabetes with neuropathy, and essential hypertension, and had intact cognition per the MDS. Physician orders included daily bupropion, clopidogrel, docusate sodium, Jardiance, losartan, and three-times-daily Lyrica for polyneuropathy. On the survey date, an LVN prepared Resident 4’s scheduled 9 a.m. medications outside the resident’s room and identified that the ordered docusate sodium 250 mg capsule was not available in the medication cart. At 11:33 a.m., the LVN administered the prepared medications (bupropion, clopidogrel, Jardiance, losartan, and Lyrica) to Resident 4, confirming these were the resident’s scheduled 9 a.m. medications. The LVN stated that Lyrica was ordered three times daily at 9 a.m., 1 p.m., and 5 p.m., and acknowledged that the 9 a.m. medications were administered late. The LVN also reported that Resident 4’s systolic blood pressure was elevated at 162. Record review of the MAR for the month showed that the docusate sodium 250 mg capsule was documented as given at 9 a.m. on the same day, despite the LVN stating that the medication had not been received and would be administered once the supply arrived. The LVN acknowledged that medications should be documented as given only after administration and that documenting prior to administration could mislead other nurses. The DON confirmed that facility policy required medications to be administered within one hour before or after the scheduled time and that the MAR only reflected scheduled times, not actual administration times. The DON stated that Resident 4’s medications were administered late, physician orders were not followed, and the MAR was signed before the docusate was actually administered, contrary to the facility’s medication administration policy.
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