Failure to Administer Medications per Physician Orders for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to administer medications according to physician orders for two residents. One resident was admitted with multiple diagnoses including hypertension, type 2 diabetes mellitus, osteoarthritis, heart failure, generalized anxiety disorder, and COPD, and had moderate cognitive impairment requiring substantial assistance with ADLs. Hospital discharge orders included several medications, some of which were paused pending further instruction, while others such as furosemide, gabapentin, guaifenesin, metformin, oxycodone, and zolpidem were ordered to be given. Facility physician orders dated the day after admission listed these medications and added lorazepam as needed for anxiety and tramadol as needed for pain. Despite the availability of these medications in the facility’s contingent supply, the medication administration record showed that no medications were administered on the day of admission. The resident later reported not receiving any evening medications on the admission date, including anxiety medication that he stated he really needed. The unit manager LPN confirmed that the floor nurse was responsible for reviewing and entering medication orders for new admissions and that the nurse should have addressed medication orders first. The unit manager verified that the resident did not receive medications per physician orders on the admission date and acknowledged that the nurse should have pulled available medications from the contingent supply. She also confirmed that the resident could have received lorazepam for anxiety if the paused orders had been clarified with the physician, and that the resident had voiced concerns about not receiving all medications. A second resident, admitted with schizoaffective disorder, dementia, chronic pain, anxiety, COPD, hypothyroidism, GERD, and epilepsy, had severe cognitive impairment and multiple standing medication orders, including lacosamide, levothyroxine, pantoprazole, trazodone, lamotrigine, buspirone, acetaminophen, and rosuvastatin. Review of the MAR for the month showed multiple missed doses of these medications on various dates, including antiepileptics, thyroid medication, GERD medication, cholesterol medication, pain medication, and anxiety medication. Nursing notes for the same period contained no documentation of medication refusals. The resident reported that nurses were not waking her up to give medications and that some nurses simply did not give her medications. The regional director of clinical services confirmed that the resident was not administered medications per physician orders, that there were no changes in condition since admission, and that there was no documentation of medication refusal. Facility policy required medications to be administered per physician orders, including required time frames.
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