Failure to Supervise Medication Administration and Lack of Order for Self-Administration
Penalty
Summary
The deficiency involves the facility’s failure to supervise a resident during medication administration and to ensure that self-administration occurred only with a physician’s order. The resident was assessed as cognitively intact but with range of motion limitations in both upper and lower extremities and was dependent on staff for all other activities of daily living. Her admission record listed multiple diagnoses, including MRSA infection, local skin and subcutaneous tissue infection, disruption of an external surgical wound, chronic kidney disease stage 3A, chronic pain syndrome, major depressive disorder, generalized anxiety disorder, extracorporeal dialysis catheter, colostomy, anemia, bilateral hip osteoarthritis, lower abdominal pain, type II diabetes mellitus, and a healing right femur fracture. During a morning medication pass, an RN administered the resident’s insulin injection and nasal spray, then placed the remainder of her morning medications in cups on the bedside table and left the room without observing her take them. The unsupervised medications included 18 different drugs, such as clonidine, buspirone, amlodipine, ferrous gluconate, liquid protein supplement, glipizide, gabapentin, losartan, lorazepam, metformin, metoprolol, oxybutynin ER, terazosin, sertraline, senna-docusate, pantoprazole, Miralax in water, and milk of magnesia. The RN documented these medications as administered and moved the medication cart down the hall. Later, the resident reported that most nurses leave her pills on the bedside table without watching her take them, that she does not like this practice because she has dropped pills before, and that pills have spilled when left on the table while she was sleeping and bumped it. She also stated she is clumsy and sometimes drops a pill. Review of the resident’s orders confirmed there was no physician order permitting her to self-administer medications. Facility staff stated that residents allowed to self-administer must have a physician’s order, and the facility’s self-administration policy specified that residents may self-administer only according to a physician’s order and under specified conditions.
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