Failure to Ensure Availability and Administration of Ordered Antianxiety Medication
Penalty
Summary
The facility failed to ensure that an ordered antianxiety medication (lorazepam gel/Ativan gel) was available and administered as prescribed for one resident. The resident had multiple diagnoses including COPD, depression, dementia with behavioral disturbance, anxiety disorder, hypomagnesemia, and dysphagia, and was care planned for verbal/physical agitation, resistiveness to care, and behavioral symptoms related to dementia and anxiety. The care plan interventions included administering medications per physician orders, specifically Depakote, lorazepam, and Rexulti. The resident had an active order for lorazepam gel 0.5 mg/ml, 1 ml topically three times daily for generalized anxiety disorder. During an observation, the resident, who had a BIMS score of 0 indicating severe cognitive impairment, was in bed requesting potato chips. After receiving chips, the resident refused an oral medication despite the nurse’s third attempt. When asked about the lorazepam gel order, the nurse confirmed the order existed but stated it was on hold and was unaware of the reason. The nurse checked the medication cart and there was no lorazepam gel available. Record review showed a current order with instructions that the pharmacy should be called every 30 days for Ativan gel, that the pharmacy would deliver to the facility, and that the medication should not be signed out unless the facility called. The Treatment Administration Records for March showed 71 possible administrations of Ativan gel, with 28 entries marked as NA (Not Available) and 4 entries marked as 5 (Hold/see nurses notes). For February, there were 84 possible administrations, with 24 entries marked NA and 15 entries marked as 5 (Hold/see nurses notes). The DON reported that the resident’s family had been paying out of pocket for the Ativan gel because it was not covered by insurance, confirmed discrepancies with the medication not being filled timely and being signed out intermittently by nursing staff, and stated that any nurse could call for a refill when the medication was not available. The DON also confirmed that the last date the medication was obtained and administered to the resident was unknown.
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