Improper In-Room Storage and Unapproved Self-Access to Topical Pain Medications
Penalty
Summary
The deficiency involves the facility’s failure to store drugs and biologicals in locked compartments under proper controls and to limit access to medications to authorized personnel, in accordance with state and federal requirements. For one male resident with chronic pain, gout, and depressive disorder, records showed severe cognitive impairment with a BIMS score of 00, chronic pain, and use of pain medication, but no care plan or clinical assessment authorizing or supporting self-administration of medications. Physician orders did not include a pain-relieving spray. During observation, the resident was not in his room, and a container of pain-relieving spray was found on top of his drawer, in plain view and visible from the hallway, a few steps from the door. The resident stated he used the spray for back pain and always kept it on top of his drawer, and he was unsure if nurses knew about it. For a female resident with osteoarthritis and a right hip fracture, records showed she was cognitively intact with frequent pain, and her care plan included administration of analgesia by staff, but there was no care plan for self-administration of medications and no clinical assessment documenting competence to manage her own medications. Physician orders did not include a pain-relieving roll-on. During observation, the resident was awake in bed with a pain-relieving roll-on on top of her overbed table at bedside. She reported that she sometimes used the pain reliever on her arthritic knees and that staff knew she had the pain reliever with her. Staff interviews confirmed that these pain-relief products were not being stored or controlled according to facility expectations and policy. An LVN stated that pain reliever sprays and roll-ons should not be inside residents’ rooms and should be kept in the nurses’ carts for administration by nurses, and that this was the first time she became aware of the products in these residents’ rooms. She acknowledged she had not noticed them during resident checks and described that residents might use them more than recommended or that confused residents might consume them. The DON stated that medications should not be stored in residents’ rooms because residents might use them inappropriately and that the pain relievers should be in the carts and administered by staff. The facility’s self-administration policy required an interdisciplinary determination, documentation in the medical record and care plan, and nursing administration of medications if residents could not safely self-administer, conditions that were not met for these two residents.
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