Improper IV Antibiotic Administration and Documentation by Licensed Nurse
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a licensed nurse administered and documented IV antibiotics according to professional standards and facility policy for two residents. One resident had been admitted with osteomyelitis and a chronic left foot ulcer and had an order for IV Cefepime 2 grams every eight hours for infection. The IV administration record showed that on a specific date, the scheduled 7 a.m. Cefepime dose was documented by a licensed nurse at 10:34 a.m. During interview and concurrent record review, the nurse acknowledged that he documented the 7 a.m. dose even though he had not administered it, based solely on a verbal report from the night shift RN that the medication had been given. He stated he should not have done this and that it did not follow standards of practice. The second resident had been admitted with sepsis and unspecified valve endocarditis and had an order for IV Vancomycin 900 mg every 12 hours for MRSA bacteremia, with a scheduled administration time of 8 a.m. The IV administration record indicated that on a specific date, the licensed nurse administered and documented the 8 a.m. Vancomycin dose at 12 p.m., four hours after the prescribed time. In interview, the nurse stated the resident had a doctor’s appointment and was not in the facility at the scheduled time, and that the resident left by transportation at 9 a.m. for a noon appointment and returned at noon. The nurse acknowledged he did not notify the physician about the missed 8 a.m. dose, did not document a change of condition related to the missed dose, and recognized he should have obtained further orders to administer the Vancomycin late and could have given the dose earlier before the appointment. Another licensed nurse stated she would never document another nurse’s medication administration and described that as wrong and not following standards of practice. She also stated that staff had access to residents’ appointment information and that she reviewed appointment schedules at the start of her shift and would notify the physician if a medication was missed due to an appointment. The DON stated that medications should be given in a timely manner, including for residents with outside appointments, that nurses were expected to plan ahead, and that the delayed Vancomycin dose could have been given an hour earlier than scheduled. The DON further stated that documenting another nurse’s medication administration was not acceptable and not the facility’s standard of practice. Facility policy on administering medications required medications to be given in accordance with prescriber orders and within one hour of the prescribed time, and required that the individual administering the medication initial the MAR after giving each medication and record their signature and title in the medical record.
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