Improper Delegation and Documentation of Lidocaine Patch Removal
Penalty
Summary
The deficiency involves failure to ensure professional standards were maintained in the delegation and documentation of nursing duties related to medication administration for one sampled resident. The resident had a physician’s order for Lidocaine 4% external patches to be applied to the left and right hips at bedtime, to remain on for 12 hours and then be removed for 12 hours. Review of the Medication Administration Record (MAR) showed that licensed nursing staff documented application of the Lidocaine patches at 8:00 PM on January 12, 2026. On the morning of January 13, the staff nurse responsible for the resident stated that Licensed Nursing Assistants (LNAs) remove the Lidocaine patches and acknowledged having no concern about signing off on the MAR for patch removal before verifying that LNAs had actually removed them. The staff nurse also stated that no LNA had reported removing the patches, yet the nurse marked the electronic MAR order for removal of the two Lidocaine patches as completed at 7:59 AM on January 13, 2026. Observation at 9:14 AM on January 13 showed the staff nurse entering the resident’s room to administer oral medications and leaving the room without checking for or removing the Lidocaine patches. Review of the facility’s LNA job description revealed no mention of assisting with medication administration, and review of training and competencies for five sampled LNAs showed no training on medication administration or assisting with medication administration. The administrator and DON both confirmed that no LNAs in the facility were certified or trained to assist with medication administration, including removal of Lidocaine patches, and that delegating this task to LNAs was outside their scope of practice and job description. The DON further confirmed that facility policy requires medications to be administered only by persons legally authorized to do so, and that the staff nurse’s delegation of patch removal to an unqualified LNA and subsequent documentation of completion without verification violated facility policy and accepted professional standards.
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