Failure to Administer and Supply Medications as Ordered and Scheduled
Penalty
Summary
The deficiency involves the facility’s failure to provide medications as ordered and according to established schedules for multiple residents. One resident with epilepsy, morbid obesity, anxiety, depression, and hypertension had orders for buspirone, carbamazepine, and losartan. On the survey date, an RN took the resident’s blood pressure at 107/60, administered an anti-nausea medication, and stated she would return to give the scheduled morning medications. Over two hours later, she acknowledged that she had not yet administered those morning medications, and documentation showed she held the losartan even though the blood pressure was not below the physician-ordered parameter to hold the drug. Another resident with multiple sclerosis, dementia, central nervous system disorder, and other conditions had orders for propranolol three times daily and primidone five times daily. On the survey date, an RN administered the 9:00 AM scheduled medications at 10:30 AM, outside the facility’s stated one-hour before/after administration window. A third resident with diabetes, diabetic retinopathy with macular edema, and other eye-related diagnoses had an order for Preservision (a multivitamin with minerals) twice daily. On the survey date, the RN reported that the ordered eye vitamin was not available. A fourth resident with polycythemia vera, osteoarthritis, dysphagia, hypertension, atrial fibrillation, heart failure, dementia, and other conditions had multiple medications ordered at 9:00 AM, including cyanocobalamin 1000 mcg, hydroxyurea 500 mg two capsules, metoprolol, Mucinex 600 mg, diltiazem three times daily, and Systane eye drops three times daily. The RN administered these medications more than one hour late, gave cyanocobalamin 50 mcg instead of 1000 mcg, one capsule of hydroxyurea instead of two, held metoprolol without any ordered parameters to do so, administered Mucinex 400 mg instead of 600 mg, gave diltiazem late, and reported that the ordered eye drops were not available. A fifth resident with diabetes, weakness, dysphagia, anxiety, hypertension, heart disease, GERD, and osteoarthritis had orders for docusate, famotidine, and metoprolol twice daily at 9:00 AM and 5:00 PM, but the RN administered the 9:00 AM medications at 11:00 AM. The regional nurse consultant stated that medications should be given within one hour before or after the scheduled time, that late medications should be reported to the physician, and that medications should only be held if there are physician-ordered parameters.
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