Unsecured Narcotic Tablet Left in Resident Room
Penalty
Summary
The deficiency involves the facility’s failure to ensure that controlled medications were properly secured and not left unattended in a resident’s room. A female resident with multiple diagnoses, including COPD, hypothyroidism, hyperlipidemia, schizophrenia, hypertension, type 2 diabetes with hyperglycemia, paraplegia, seizure disorder, and fall risk, was totally dependent on staff for all ADLs and required supervision with eating and for safety. Her care plan required that the call light be kept within reach at all times. Physician orders included Nucynta ER (tapentadol) 150 mg, a Schedule II narcotic, to be given once daily for pain. 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 entered the room around 6:00 a.m. to provide care and observed a blue pill in a cup on the resident’s side table. The resident told the CNA she did not know how the pill got there and stated that the nurse must have placed it there the previous night. The resident also stated she informed an RN about the pill and showed it to him. The CNA later returned to the room and found that the resident still had the pill in her possession. The RN confirmed that the resident showed him the pill and that he then took it into his possession. He stated that the night nurse, an LVN, told him she had given the resident a PRN narcotic and signed it as wasted in the narcotic book because the resident did not take it, and he acknowledged the pill should never have been left. The LVN stated that a medication aide (MA) had signed out the pill and left it on the resident’s table, and that all medications were supposed to be observed as taken by the resident. Another LVN, who trained the MA, stated that at no time would she or her trainee place a pill in a cup and leave it by a resident’s desk, and that MAs are trained to administer medications and observe ingestion. The DON stated that the pill found in the resident’s room was not appropriate. Facility policy on medication management required that authorized staff remain with the resident while medication is swallowed and to never leave medication in a resident’s room without an order to do so. The narcotic record showed that on the relevant evening, one Nucynta ER 150 mg tablet was documented as given and wasted by the LVN.
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