Failure to Include and Use Measured Dose for Topical Diclofenac Gel
Penalty
Summary
The facility failed to ensure that a prescribed topical medication included dosing information and was administered in a measured amount for one resident. The resident was admitted with diagnoses of cervicalgia and unspecified osteoarthritis. An order dated 2/25/2026 for Diclofenac Sodium 1% external gel directed staff to apply the gel to the resident’s neck and back every day and on the night shift for primary osteoarthritis, but the order did not specify the dose. Review of the manufacturer’s instructions for Diclofenac sodium topical gel showed that the medication is to be measured using dosing cards, with application within the oblong area of the card up to the 2‑gram or 4‑gram line, and a total daily dose not to exceed 32 grams. During observation of a medication pass, an LPN applied an unmeasured amount of Diclofenac gel to the resident’s neck rather than using a measured dose. The Interim DON confirmed that medication orders are required to include the resident’s name, medication dose, time of administration, route of administration, and prescriber name, and that orders missing information should be corrected after notifying nursing and pharmacy. Review of the prescription label for the resident’s Diclofenac sodium topical gel with the Interim DON confirmed that the label lacked dose information, even though the manufacturer’s instructions and dosing card were available in the medication box.
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