Failure to Administer Ordered PRN Cough Medication per Physician Orders and Resident Requests
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident received medications in accordance with professional standards and physician orders. The cognitively intact resident, admitted with chronic bronchitis/COPD and recovering from influenza, had physician orders for PRN Benzonatate (Tessalon) capsules for cough and later for PRN Guaifenesin syrup. The care plan did not document the resident’s chronic bronchitis, COPD, cough, or related physician-ordered medications. Medication administration records showed Benzonatate was ordered twice over specified time frames and was not administered on several days when it was available and ordered, including multiple missed days during the second order period. None of the administered Benzonatate doses were initialed by the RN later implicated in the complaint. During interviews, the resident reported repeatedly requesting Tessalon on multiple days and being told he could not have it, stating that an RN became defensive, refused to give the ordered Tessalon, and instead offered cough syrup. Another LPN confirmed the resident had a persistent cough, regularly requested Tessalon, and that the medication was stored in the cart and not unavailable. A CNA reported the resident frequently became upset about not receiving medications on time. The RN in question stated the resident frequently requested Tessalon but claimed there was no order for it, did not notify the physician, and did not recall administering cough syrup, despite records showing she had administered Guaifenesin on three occasions. The nurse manager confirmed there was an issue with this RN not honoring the resident’s request for cough medication, that the resident had a valid physician order for Tessalon, and that the medication was available and should have been administered. A provider visit note documented the resident’s multiple complaints about medications and timing following treatment with Tessalon and Tamiflu for influenza A and ongoing intermittent dry cough.
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