Improper Handling and Documentation of Controlled Pain Medication
Penalty
Summary
The deficiency involves the facility’s failure to provide pharmaceutical services and follow procedures for accurate administration and documentation of a controlled medication for one resident. The resident was an older female with multiple diagnoses including COPD, hypothyroidism, hyperlipidemia, schizophrenia, hypertension, type 2 diabetes with hyperglycemia, and paraplegia, and was totally dependent on staff for ADLs with care plan directions to keep the call light within reach. She had a physician’s order for Nucynta ER (tapentadol) 150 mg once daily for pain. The facility’s medication management program required that authorized staff remain with the resident while medication is swallowed and never leave medication in a resident’s room without an order to do so. The resident reported that over a weekend a nurse put a narcotic pill in a cup and placed it on her side table while she was asleep. The next morning, a CNA providing care around 6:00 a.m. observed a blue pill in a cup on the resident’s side table and questioned the resident, who stated she did not know how the pill got there and believed the nurse had left it the previous night. The resident stated she informed an RN and showed him the pill, and the CNA later returned and found the pill still in the resident’s possession. In a subsequent interview, the RN confirmed that the resident showed him the pill, that he then took the pill into his possession, and that he spoke with the night nurse, who told him she had given a PRN narcotic and signed it as wasted in the narcotic book because the resident did not take it. The night LVN stated she worked that weekend, was informed by the CNA about the narcotic pill in the resident’s room, and acknowledged that medications are to be observed while the resident takes them. She stated that a medication aide had signed out the pill and left it on the resident’s table, and that the pill was already signed out as wasted when she looked at the narcotic record. Another LVN, who trained the medication aide, stated she was familiar with the resident’s medications, had observed the aide administer scheduled narcotics in the morning, and denied that she or the aide would place a pill in a cup and leave it by a resident’s desk, reiterating that aides are trained to observe residents taking medications. The medication aide reported she only administered scheduled medications that morning, observed the resident take them, did not administer in the evening, and stated that the tapentadol in question was a PRN medication that only nurses could administer. Review of the controlled drug receipt/record/disposition form showed that on the evening in question, the night LVN documented giving one tablet of Nucynta, with an amount left of ten, and signed it as “wasted (missed dose),” indicating improper documentation and handling of the controlled drug.
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