Improper Storage and Unauthorized Self-Administration of Pain Patches
Penalty
Summary
Surveyors identified a deficiency in the facility’s handling of medication storage and administration for one resident using lidocaine 5% pain patches. During observation, the resident was found lying in bed with medication patches on her bedside table, which she stated were for knee pain and that she would apply when ready. During the same interaction, she placed both patches below each knee herself and reported that she always applies and removes them on her own. A subsequent interview with an RN confirmed that nurses give the patches to the resident and that the resident applies them herself. Record review showed active MAR orders for lidocaine 5% external patches to be applied topically to the left and right knees for pain management, with nurses signing these medications as given. However, there was no physician order authorizing self-administration of the lidocaine patches and no corresponding self-administration assessment for these patches in the electronic medical record. The only self-administration assessment on file, dated several months earlier, pertained to a different medication. This practice conflicted with the facility’s own policies, which require medications to be stored securely and accessible only to authorized staff, and which state that self-administration must be determined by the interdisciplinary team and supported by a specific order after assessing the resident’s ability to self-administer.
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