Failure to Assess and Authorize Resident Self-Administration of Medications
Penalty
Summary
The facility failed to determine whether self-administration of medications was clinically appropriate for a cognitively intact resident on dialysis who was reviewed for self-administration of drugs. The resident had diagnoses including renal dialysis, end stage renal disease, gastrointestinal hemorrhage, and anemia, and the quarterly MDS showed the resident was cognitively intact with no behaviors. Despite this, the resident was not care planned for self-administration of medications, and there was no assessment in the electronic medical record regarding the resident’s ability to self-administer medications. The physician’s orders did not include naproxen sodium or lidocaine-prilocaine cream, nor did they include any order authorizing the resident to self-administer medications. Surveyor observation found an opened bottle of naproxen sodium 500 mg and four opened tubes of prescription lidocaine-prilocaine cream on the resident’s overbed tray table while the assigned medication aide was outside the room at the medication cart and unaware that these medications were present. The resident reported that he kept naproxen in his room to take for headaches and that he applied the lidocaine cream to his fistula prior to dialysis, stating that his responsible party had brought these medications from an outside pharmacy. The physician stated that the resident should not self-administer naproxen or lidocaine cream without supervision and that residents were to be assessed for safe self-administration. The unit manager and DON both confirmed that residents must be assessed for self-administration, require a physician’s order specifying which medications may be self-administered, must have medications stored properly, and must have the care plan updated, and both stated they were unaware that this resident was self-administering and keeping these medications unsecured in the room.
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