Improper Handling and Administration of Controlled Pain Medications
Penalty
Summary
The deficiency involves the facility’s failure to follow its own oral medication administration and controlled substance policies when handling a resident’s opioid pain medications. The resident, admitted with diagnoses including depression, diabetes, right above-knee amputation, and paraplegia, had an order for Morphine Sulfate ER 60 mg by mouth every 12 hours for osteoarthritis and no order or assessment to self-administer medications. Facility policy required staff to remain with residents until medications were swallowed and prohibited leaving medications at the bedside unless specifically ordered. During observation, surveyors saw a brown pill in a medication cup with water on the resident’s bedside table with no staff present; the resident stated it was his/her medication and then self-administered it. An LPN reported having given the resident morphine earlier and speculated the resident must have spit it out, while a CMT stated the resident’s medications had not yet been given and that medications should not be left in the room. Further observations showed additional failures in controlled substance handling. During a skin assessment, the ADON found a small round white pill under the resident in bed, initially assumed it was morphine, placed it on the bedside table, and later crushed and disposed of it at the medication cart. Upon checking the narcotic box, the ADON determined the pill was Oxycontin, a Schedule II opioid for which the resident had no physician order, and noted that another resident on the unit had a card of Oxycontin in the narcotic box. The resident’s prescribed morphine was described as a small brown pill matching the medication seen at the bedside earlier. The DON and Administrator stated they would not expect controlled medications to be in a resident’s bed or for a resident to have medications not prescribed to him/her, and another ADON stated that nurses should sign out narcotics as they are pulled and ensure residents take medications before leaving the room. Resident #7 was not known to pocket or spit out medications.
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