|§ 483.25 Quality of care |
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
Based on a review of clinical records, facility documentation, and interviews with facility staff, it was determined that the facility failed to provide medications as ordered by the physician for one of three resident records reviewed. (Resident R1)
Resident R1 was admitted to the facility at approximately 4:00 p.m. on May 17, 2019, from a hospital to continue treatment of the left foot with a wound vacuum (vacuum to assist closure of a wound and to promote healing), and intravenous antibiotics. The resident diagnoses included Diabetes (the body's inability to produce insulin which enables sugar to pass from the blood stream to the cells for nourishment), Abscess (swollen area within body tissue containing an accumulation of pus) with MRSA (Methicillin- Resistant Staphylococcus Aureus, more complicated infection due to the resistance of common antibiotics) infection of the left great toe, Depression (loss of interest in pleasurable activities, change in sleep patterns, appitite and routine), Obesity (excessive amount of body fat), and had a PICC line (catheter placed in a large vein that carries blood to the heart), and had an order to be non weight bearing on the left foot.
The resident admission assessment indicated that the resident had a BIMS (brief interview for mental status) of 15, which indicated the resident was cognitively intact. The Director of Nursing stayed beyond her shift to complete admission documentation for the new later admission, she forwarded the orders to the physician who responded and confirmed the orders by 7:43 p.m. The resident was due to receive 9:00 p.m. medications as follows; Buspirone 10 milligrams, for anxiety, Sertraline 100 milligrams, an anti depressant, Lipitor 40 milligrams, a cholesterol lowering medication, Accucheck (fingerstick to determine a persons blood glucose level) and an intravenous antibiotic Vancomycin 500 milligrams every twelve hours due at 9:00 p.m. to be administered through the PICC line. Review of documentation on June 4, 2019, revealed that the MAR ( medication Administration Record) was not signed by the nurse. There were no initials documented on the MAR indicating that the medications were given, and Nursing progress notes did not include any reference that these medications were provided to the resident. The facility has a Omnicell cabinet ( automated medication dispensing cabinet) which makes medications readily available for residents who are new admissions after verification is received by the physician, or a needed medication for a new order. Review of medications included in the Omnicell cabinet revealed that all of the medications ordered for the resident at 9:00 p.m. were available, but were not dispensed and provided to the resident as indicated in the physician's admission orders.
Interview with the Director of Nursing on June 4, 2019, at 2:45 p.m. confirmed that the resident had not received the 9:00 p.m. medications, which were available in the Omnicell. The facility policy "Admissions- Rules and Regulations" noted as new and reviewed on 11/ 2017, indicated that "Any medications needing to be administered after admission orders are verified with the attending physician should be obtained from the Omnicell".
The facility failed to obtain and administer medications as ordered by the physician to Resident R1.
28 Pa. Code 211.12 (d)(1)(5) Nursing services.
Previously cited 8/16/18 and 9/14/17.
| ||Plan of Correction - To be completed: 07/30/2019|
As related to R1, the facility is unable to correct the deficiency as the resident is no longer a resident of our facility. To prevent reoccurrence of this violation and protect all residents from similar situations (including new admissions) in regard to receiving medications and appropriate treatments, the following plan of correction will be implemented.
Policies and procedures for providing Pharmaceutical services is being reviewed and will be updated if needed to include procedures that assure accurate acquiring, receiving, dispensing and administration of all medications to meet the needs of residents. The following will be implemented to insure reoccurrence of this practice does not occur.
1.Professional nurses (RN and LPN) will be reeducated on the use of the Omnicell (automated dispensing system).
2.Professional nurses (RN and LPN) will be reeducated on the Admission process.
3.In the event that any medication or treatment is not available in a timely manner, the attending physician and/or medical director will be notified for an appropriate alternative.
4.The Supervisors will be responsible for ensuring that all medications and treatments are completed in a timely manner.
5.IV Medications in Omnicell will be reviewed and updated if needed to insure availability. All IV medications will be called to the Pharmacy as soon as orders confirmed by attending physician.
6.DON/ADON and/or designee will review new admissions to ensure medications and treatments were received and implemented in a timely manner. This will be monitored and reported to the quarterly Quality Assurance Program Improvement meeting.
The Director of Nursing and/or designee is responsible for the implementation and compliance with this plan of correction.