Failure to Follow Hand Hygiene and Medication Handling Practices During Medication Administration
Penalty
Summary
The deficiency involves failures in hand hygiene and medication handling for two residents during medication administration. For one resident with multiple diagnoses including cerebral infarction, hemiplegia, heart disease, morbid obesity, and type 2 diabetes, the care plan included administration of medications as ordered. During observation, an LPN removed two thiamine tablets from the container into the medication cup lid, then used a bare finger to hold one tablet in the lid while shaking the other tablet back into the container. The LPN confirmed she was not wearing gloves and acknowledged she should have discarded the tablets and started over. This practice conflicted with the facility’s medication administration policy, which required that medications not come into contact with any surface except the medication cup and that staff avoid touching medications with bare hands. For a second resident with extensive medical conditions including epilepsy, respiratory failure with hypoxia, tracheostomy, CHF, dysphagia, and dependence on a respirator, an RN prepared multiple medications according to the resident’s preference for crushed, whole, and liquid forms. The RN had three medication cups on the cart and, using bare hands, picked up a small white pill from one cup and moved it to another. The RN then donned gloves to open capsules and crush medications, mixed two liquid medications together, and later donned gloves and a gown in the resident’s room without performing hand hygiene beforehand, despite the resident being on Enhanced Barrier Precautions. The RN confirmed she had handled the pill with bare hands and had not washed or sanitized her hands before putting on gloves and a gown. These actions were inconsistent with the facility’s General Dose Preparation and Medication Administration policy and Infection Prevention and Control Program, which required appropriate hand hygiene before medication preparation and administration and avoidance of bare-hand contact with medications.
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