Failure to Assess and Authorize Resident Self-Administration of Nasal Spray Kept at Bedside
Penalty
Summary
The facility failed to assess and authorize a cognitively intact resident’s ability to self-administer a prescribed steroid nasal spray that was kept at bedside. The resident had a physician’s order for fluticasone propionate nasal suspension, 50 micrograms, two sprays in both nostrils twice daily for allergies. The quarterly MDS documented that the resident was cognitively intact, and the DON and Medical Director both acknowledged the resident had the potential or ability to self-administer medication. However, the resident’s care plan contained no goals or interventions related to self-administration of medications, and the medical record did not contain any assessment for self-administration or an order permitting the resident to keep the nasal spray at bedside. Surveyors observed the resident’s prescribed nasal spray on the overbed table on multiple occasions over two consecutive days, and the resident stated that a nurse had left it in the room and that she knew she should not have it there, but it made it easier to use when needed. A nurse assigned to the resident stated she was unsure of the process for residents who self-administer medications, believed no residents on that hall self-administered, and said she would remove any medication found in a resident’s room, yet she had not noticed the nasal spray earlier that day when administering medications. During an interview and concurrent room observation, this nurse then discovered the nasal spray on the overbed table behind a tissue box and removed it. The DON and Administrator both described a facility process requiring an assessment, an order, a lock box, and care plan interventions for self-administration, and both stated they were not aware of residents on that hall self-administering medications, confirming that these required steps had not been completed for this resident despite the medication being left at bedside.
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