F0756

D

Failure to Obtain Physician Response to Pharmacist Recommendation for Steroid Inhaler Use

Weiser, Idaho Survey Completed on 02-20-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that a physician responded to a pharmacist’s documented recommendation following a monthly drug regimen review. The facility’s Pharmacist Consultation Policy, revised 9/16/25, required that irregularities identified by the pharmacist be reported to the provider and that the provider document acceptance or rejection of the recommendations in the medical record. For one resident reviewed for unnecessary medications, Resident #48, the pharmacist completed a Consultation Report on 11/11/25 recommending that the resident rinse and spit after use of budesonide (Symbicort) to align with the medication’s prescribing information, which warns of localized Candida albicans infections of the mouth and throat and advises rinsing the mouth after inhalation.

Resident #48 had a physician’s order dated 9/26/25 for budesonide (Symbicort) inhalation twice daily for COPD. The pharmacist’s Consultation Report specifically requested consideration of adding “rinse mouth out and spit after use” to the budesonide order, but there was no documentation that the physician responded to this recommendation, and the resident’s medication order was not updated to include the mouth-rinsing instruction. A handwritten “Standard of Care” notation appeared at the bottom of the Consultation Report, and during an interview, the DON stated that nurses were expected and trained to advise residents to rinse their mouths after using a steroid inhaler, but acknowledged that the physician’s order had not been updated because it was only a pharmacist recommendation. This lack of documented physician response and order update was identified for 1 of 6 residents reviewed for unnecessary medications and created the potential for the resident to develop oral thrush.