Unnecessary Prolonged Use of Topical Steroid and Antifungal Medications
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s medication regimen was free from unnecessary drugs. Review of the physician order sheet showed continuous orders for triamcinolone acetonide 0.1% ointment twice daily for fungal dermatitis starting 9/17/25 with no stop date, and miconazole nitrate 2% cream daily for groin fungus starting 5/27/25 with no stop date. Medication administration records from May 2025 through February 2026 showed both topical medications were administered as ordered for extended periods, with triamcinolone given twice daily for five consecutive months and miconazole given daily for nine consecutive months. During interviews and observations, an LPN reported that the resident’s groin redness was intermittent and related to hygiene, and that he continued to apply both ointments daily even when the skin appeared clear. On observation, the resident’s bilateral groin was clear with no redness, and the resident stated the redness had resolved about a month earlier while staff continued applying both medications. The Infection Preventionist RN confirmed the orders were written as continuous rather than as needed despite the intermittent nature of the condition. The Infectious Disease NP stated that triamcinolone has potential side effects when used long term and that both triamcinolone and miconazole are usually temporary treatments, indicating triamcinolone should be discontinued and miconazole used only as needed. The facility’s own medication administration policy requires staff to contact a prescriber if a medication is believed to be inappropriate, excessive, or associated with potential adverse consequences, which was not done in this case.
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