Failure to Administer PRN Antipyretic and Monitor Fever
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered care and monitoring for a resident who developed a fever. The resident was admitted with diagnoses including lack of coordination, dysphagia in the oropharyngeal phase, and urinary retention, and had moderately impaired cognitive skills for daily decision-making, requiring setup or cleanup assistance with eating, oral hygiene, and personal hygiene. The resident’s vital sign record showed a documented temperature of 100.1°F late in the evening, which met the threshold for a PRN order for acetaminophen 325 mg, two tablets by mouth every six hours as needed for fever greater than 100°F. However, there was no documentation that the resident’s temperature was monitored or reassessed after this elevated reading. Interview and record review revealed that the nurse on duty acknowledged the resident’s temperature was elevated from the previous shift and stated it was the licensed nurse’s responsibility to monitor any change of condition and elevated temperatures, to see if the temperature decreased, and to administer medication as ordered. The nurse reported taking the resident’s temperature but not having time to document it. The DON confirmed that licensed staff failed to administer the ordered acetaminophen for the fever and stated that licensed staff should assess, give medication as ordered, and continue monitoring for fever. Review of the facility’s change of condition/quality of care policy indicated that nurses are required to perform and document an assessment, implement existing orders or obtain new orders, and provide at least three days of observation and documentation for residents with a change in condition, which was not carried out in this case.
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