A resident’s J-tube medications were prepared and crushed before administration, then given by an RN without verifying tube placement first. The eMAR also showed medications documented under an MNA’s login even though the MNA said he or she did not administer them, and another RN stated the meds had already been crushed before being called to give them.
Insulin was not administered per manufacturer instructions for a resident receiving Novolog insulin on a sliding scale for DM. During observation, an LPN used the insulin pen and held the plunger for about 4 seconds, and the LPN confirmed the observation. Manufacturer directions stated the needle should remain in the skin for at least 6 seconds and the button should stay fully pressed until the needle is removed to ensure the full dose is given.
A resident’s scheduled Ativan was not administered for several days because the medication was unavailable, and the progress notes did not document that the provider was notified. An RN confirmed the MAR and chart review findings.
The facility failed to follow ordered weight monitoring and failed to notify the provider of missed or abnormal weights for two residents. One resident with CHF, cirrhosis, anasarca, and AKI had daily weights ordered, but the record showed missed weights, a 12.2-lb loss, a 7.1-lb gain, and refusals without provider notification or reweigh documentation. Another resident had ordered weekly weights after admission, but several weekly weights were not documented and the provider was not notified when the weights were not obtained.
A resident receiving Humalog Kwikpen insulin was given a 2-unit dose by an RN without priming the pen first. The RN confirmed the pen had not been primed per manufacturer instructions, even though the resident’s CBG of 168 required 2 units per the sliding-scale order.
Medication administration and wound care deficiencies were identified for multiple residents. An LPN gave a medication via G-tube without verifying tube placement or patency, an opioid was administered outside the ordered pain parameters, and a resident with a bleeding leg wound and a history of skin picking had no documented wound dressing order despite the open area being observed and confirmed by staff.
Failure to follow physician orders occurred when an RN administered the wrong dose of trazodone to a resident with insomnia, giving 25 mg instead of the ordered 75 mg. In a separate finding, a resident with CHF had a daily weight order, but weights were missed on multiple days, and the RDCS confirmed the omissions.
Medication administration standards were not followed for two residents. One resident received multiple doses of metoprolol succinate ER and Enestro even when recorded BP values were below the ordered hold parameters, and the DON confirmed the MAR findings. For another resident, an LPN marked Bupropion HCl as given in the EMAR even though the tablet was not placed in the medication cup, then administered the remaining medications without verifying the cup contents.
A facility failed to follow ordered wound care for two residents and administered gabapentin incorrectly to another resident. One resident’s lower leg dressings and another resident’s heel dressing were documented as completed, but observations showed the dressings were older than ordered and had not been changed as scheduled; staff confirmed the care was not done when required. During medication pass, an LPN gave gabapentin based on the bingo card instructions instead of the provider’s order, and the APN confirmed the ordered dose was different.
An LPN administered 14 units of Novolog FlexPen to a resident without priming the pen with 2 units as directed by the manufacturer. Surveyors observed the medication pass, reviewed the manufacturer’s instructions, and confirmed the omission with the LPN. The resident had an order for daily subcutaneous Novolog.
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