|§483.45 Pharmacy Services|
The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in §483.70(g). The facility may permit unlicensed personnel to administer drugs if State law permits, but only under the general supervision of a licensed nurse.
§483.45(a) Procedures. A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.
§483.45(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who-
§483.45(b)(1) Provides consultation on all aspects of the provision of pharmacy services in the facility.
§483.45(b)(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and
§483.45(b)(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.
Based on clinical record review and staff and resident interview, it was determined that the facility failed to ensure the availability and administration of physician ordered medications for three of six residents reviewed (Residents 66, 87, and 116).
Review of Resident 66's clinical record revealed a physician's order dated January 22, 2019, for the nursing staff to administer Acetaminophen (pain reliever), 500 mg (milligrams) tablet twice daily for pain. Review of Resident 66's Medication Administration Record (MAR, a form used to document the administration of medications) dated August 2019, revealed that the nursing staff did not administer Resident 66's Acetaminophen on the evening of August 30, 2019, and noted the medication as 'held." A nurse's note dated August 30, 2019, at 4:31 PM noted that Resident 66's Acetaminophen 500 mg was held due to waiting on the pharmacy.
Further review revealed Resident 66 had an order dated January 22, 2019, for the nursing staff to administer Levetiracetam (a medication used to control seizures), 500 mg tablet twice a day. Review of Resident 66's MAR dated September 2019, revealed the nursing staff documented the morning dose of the Levetiracetam 500 mg on September 3, 2019, as "held." A nurse's note dated September 3, 2019, at 1:59 PM noted the Levetiracetam 500 mg tablet was held because it was not being available.
Clinical record review for Resident 66 also revealed the resident received a physician's order on September 2, 2019, for Macrobid (antibiotic) 100 mg, to be administered by nursing staff twice a day for seven days (last day to be September 8, 2019) for a urinary tract infection. Review of Resident 66's MAR for September 2019, revealed the resident was not administered the Macrobid on the evening of September 3, or the morning of September 4, 2019. A nurse's note dated September 4, 2019 at 9:53 PM noted the resident's physician was made aware of the missed doses of Macrobid, and new orders were received on September 4, 2019, for the resident to be administered the Macrobid 100 mg twice a day for seven days to be completed on September 11, 2019, (three days later than the original completion date due to the missed doses).
Clinical record review for Resident 87 revealed a physician's order dated January 21, 2019, for the nursing staff to administer Pepcid (an acid reducer) 20 mg tablet twice daily, Namenda XR (a medication used to treat dementia) 14 mg capsule daily, and an order dated August 2, 2019, for the nursing staff to administer Escitalopram oxalate (a medication used to treat depression and anxiety) 5 mg, tablet daily for depression. A review of Resident 87's MAR dated September 2019, revealed the resident's morning dose of Pepcid, daily dose of Namenda, and daily dose of Escitalopram Oxalate, was noted as "held" on September 4, 2019. A nurse's note dated September 4, 2019 at 1:36 PM noted the resident's Pepcid, 20 mg tablet, Namenda ER 14 mg capsule, and the Escitalopram Oxalate was held because it was not available.
Clinical record review for Resident 116 revealed the following physician's orders:
January 22, 2019, K-Dur (a potassium supplement) 20 milliequivalents (MEq) twice daily
Roxanol (a medication used to treat moderate to severe pain ) 20 mg/ml (milliliter) solution at a dose of 0.25 ml at bedtime
August 30, 2019, for Levothyroxine Sodium (a medication used to treat thyroid conditions) 150 mcg (micrograms) to be administered daily
A review of Resident 116's MAR dated September 2019, did not reveal any evidence that the resident's K-Dur was administered on the evening of September 3, 2019, that her Roxanol was administered on September 16, 2019, or that the Levothyroxine was administered on September 3, 2019.
There was no evidence of any documentation indicating why Resident 116 was not administered the medications as noted above.
The surveyor reviewed the above findings for Residents 66, 87, and 116, during an interview with the Nursing Home Administrator and the Director of Nursing on September 13, 2019, at 3:00 PM.
28 Pa. Code 211.9(k) Pharmacy services
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
Previously cited 4/12/19
28 Pa. Code 211.12(c) Nursing services
| ||Plan of Correction - To be completed: 10/22/2019|
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements.
1. Residents 66, 87 and 116 have medications as ordered.
2. House audit to assure all ordered medications are available and accessible.
3. Staff education of pharmacy policy regarding appropriate steps to acquire ordered medications. LPNs will show exception report to Charge RN at the end of each shift to ensure availability of medications and to report any medications not given due to unavailable.
4. DON or designee will audit weekly to ensure availability of medications x 3 months with results reported to QAPI.