Failure to Administer and Document Medications After Resident Vomiting Episode
Penalty
Summary
The deficiency involves the facility’s failure to provide pharmaceutical services that ensured accurate acquiring, receiving, dispensing, and administering of medications for a cognitively intact resident with multiple complex medical conditions. The resident, an older female with diagnoses including a left tibia fracture, type 2 DM, paroxysmal atrial fibrillation, cerebral infarction, chronic kidney disease, hyperlipidemia, depression, edema, and other conditions, had multiple scheduled medications ordered, including Tramadol for pain, Atorvastatin for hyperlipidemia, Farxiga for DM, Remeron for depression, Eliquis for cerebral infarction, and Protein Oral Liquid for wound healing. The resident’s care plan and orders directed that medications be administered as ordered, with monitoring for side effects, effectiveness, and documentation of relevant symptoms such as nausea and vomiting. On the date in question, CMA A was responsible for administering the resident’s medications, including the bedtime doses of Tramadol, Atorvastatin, Farxiga, Remeron, Eliquis, and Protein Oral Liquid. The MAR reflected that all of these medications were documented as administered by CMA A. However, CMA A later reported that each time she administered medications to the resident that day, the resident regurgitated the medications. During the evening medication pass, CMA A stated she made three attempts to administer the medications: on the first attempt, the resident refused; on the second attempt, the resident spat the medications out; and on the third attempt, while a family member was present, the resident again regurgitated the medications. CMA A stated that on the last attempt she gave the resident half of the medications and, when the resident could not keep them down, she threw the remaining medications away, but she was unable to specify which medications were actually taken or discarded. Despite these events, the clinical record, including the MAR and nursing notes, contained no documentation of the resident’s vomiting, no assessment of the resident’s condition related to the regurgitation, and no evidence of physician notification or monitoring for adverse events. CMA A acknowledged awareness of the vomiting episodes and stated that protocol required reporting such events to the nurse and documenting when a resident refused or vomited medications, but there was no documentation to support that this occurred. The DON reported that she only became aware of the vomiting incident after a family complaint several days later. The resident’s family member described witnessing CMA A crush the medications into a thick, pasty mixture, administer approximately half by spoon, observe the resident regurgitate the medications, and then state that the remaining portion was thrown away because the resident was not going to keep it down. The facility was unable to provide a medication administration policy that addressed these practices, and the failures resulted in the resident missing at least one dose each of Tramadol, Atorvastatin, Farxiga, Remeron, Eliquis, and Protein Oral Liquid on that date. The survey findings specifically note that these failures could place residents at risk for not receiving therapeutic dosages of their medications as ordered by the physician and a potential for decreased health status and decreased quality of life.
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