Late Administration of Scheduled Medications Outside One-Hour Window
Penalty
Summary
The deficiency involves the facility’s failure to provide pharmaceutical services by not administering scheduled 9 a.m. medications within the facility’s required one-hour before or after window for two residents. For the first resident, who had severe cognitive impairment and required substantial to maximal assistance with eating, oral hygiene, and personal hygiene, the admission and assessment records showed multiple diagnoses including type 2 diabetes with circulatory complications, hypertension, and dysphagia. The resident’s February medication orders included aspirin, ferrous gluconate, furosemide, metoprolol, a multivitamin, Tamiflu, spironolactone, and sacubitril-valsartan. Review of this resident’s Medication Audit Report for early February showed that on a specific date all eight of the resident’s 9 a.m. medications were administered at 11:27 a.m., which was 1 hour and 27 minutes after the scheduled time and outside the facility’s stated one-hour window. For the second resident, who had moderate cognitive impairment and required setup or clean-up assistance with eating, oral hygiene, and personal hygiene, the admission and assessment records documented diagnoses including lack of coordination, dysphagia in the oropharyngeal phase, and urinary retention. This resident had an order for Tamiflu 30 mg to be given twice daily for influenza. The Medication Audit Report for the second resident showed that on the same date the 9 a.m. Tamiflu dose was administered at 11:37 a.m., 1 hour and 37 minutes after the scheduled time, also outside the one-hour window. In interviews, one LVN stated that medications should be given one hour before or after the scheduled time and reported being behind on the medication pass due to having multiple tasks. Another LVN stated that the late administration for the second resident was due to a pharmacy delivery delay and acknowledged responsibility to follow up with the pharmacy if medications were not delivered on time. The DON confirmed that scheduled medications were to be administered within one hour before or after the scheduled time to ensure effectiveness and minimize side effects, and facility policy dated January 2017 specified that medications are to be administered within 60 minutes of the scheduled time unless otherwise specified by the prescriber.
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