Failure to Document PRN Narcotic Administration on MARs
Penalty
Summary
Surveyors found that the facility failed to ensure that medication administration records (MARs) accurately reflected the administration of PRN narcotic pain medications for three residents. For Resident E, who had diagnoses including osteoarthritis, lymphedema, diabetes, and depression, a physician’s order dated 1/21/26 directed Hydrocodone-Acetaminophen 5-325 mg every 6 hours as needed for pain. The March 2026 controlled drug record showed multiple administrations of this narcotic throughout the month, but the March 2026 MAR contained no corresponding documentation of these doses. During the survey, a staff member stated that when a PRN pain medication is administered, the MAR should be signed by the nurse, and the facility’s Medication Administration Policy Guideline dated 1/25/19 required that the MAR be initialed by the person administering the medication. Similar discrepancies were identified for Residents H and L. Resident H, with diagnoses including diabetes and depression, had a physician’s order dated 3/21/26 for Tramadol 50 mg every 6 hours as needed for pain. The March 2026 controlled drug record documented several administrations of Tramadol, but the March 2026 MAR lacked documentation of these doses. Resident L, diagnosed with diabetes, depression, and fibromyalgia, had an order dated 5/21/25 for Hydrocodone 5-325 mg every 4 hours as needed for pain. The March 2026 controlled drug record listed frequent administrations of this narcotic throughout the month, yet the March 2026 MAR did not contain documentation of these administrations. These findings showed that the facility did not maintain MARs in accordance with its own policy and accepted professional standards for these three residents.
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