§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(f). 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.
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Observations:
Based on clinical record review and staff interview it was determined that the facility failed to ensure that the pharmacy provided medications timely for two of four residents reviewed (Residents 1 and 3).
Findings include:
Review of Resident 1's clinical record revealed Resident 1 was admitted March 29, 2025, with diagnoses of but not limited to hypertension (high blood pressure), hyperlipidemia (high levels of fats in the blood), COPD (chronic obstructive pulmonary disease - progressive lung disease characterized by chronic respiratory symptoms and airflow limitation), and surgical aftercare following aortocoronary bypass graft (heart bypass surgery - procedure to restore blood flow to areas of the heart),
Review of physician's admissions orders revealed a start date of March 30, 2025, for the following medications: Metoprolol Succinate ER (extended release) 50 MG (milligrams), one tablet by mouth twice a day for hypertension (high blood pressure), Spironolactone Oral Tablet 25 MG, one tablet by mouth one time a day for Hypertension, Ezetimibe Oral Tablet 10 MG one tablet by mouth one time a day for hyperlipidemia (high cholesterol), Anoro Ellipta Inhalation Aerosol one puff inhale orally one time a day for COPD/shortness of breath/wheezing, guaifenesin ER Oral Tablet 600 mg one tablet by mouth two times a day for cough/acute bronchitis, Clopidogrel Bisulfate Oral Tablet 75 mg one tablet by mouth one time a day for ASHD (ateriosclerotic heart disease)/history of long term anticoagulant (blood thinner) use, and Viactiv Calcium Immune Oral Tablet Chewable one tablet by mouth one time a day for supplement.
Review of the March 2025 Medication Administration Record (MAR) revealed that the above medications were not administered as ordered.
Review of orders administration note of March 30, 2025, revealed staff were "waiting for delivery" for the above medications.
Review of Resident 3's clinical record revealed that Resident was admitted April 16, 2025, with a diagnosis of , but not limited to hypopituitarism (decreased secretion of one of the hormones normally produced by the pituitary gland).
Review of physician admission orders revealed a start date of April 16, 2025, for Desmopressin Acetate Oral Tablet 0.1 MG one tablet by mouth two times a day for hypopituitarism and Hydrocortisone Oral Tablet 5 MG 0.5 tablet by mouth two times a day for hypopituitarism.
Review of the April 2025 MAR revealed that the above medications were not administered as ordered.
Review of orders administration note of April 16, 2025, revealed staff were "awaiting pharmacy".
Interview with the Director of Nursing on April 30, 2025, at 12:15 p.m. confirmed that Residents 1 and 3 did not receive their medications as ordered because they were not available from the pharmacy.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
Previously cited 10/9/24
| | Plan of Correction - To be completed: 05/27/2025
Resident 1 and resident 3 have discharged from the facility.
EMAR of New admissions in the last 7 days will be reviewed to assure that medications were administered per physician orders.
Licensed Nursing Staff will be educated by DON/designee on the importance of assuring that medications are administered per physician orders
Audits on new admissions EMAR will be conducted to ensure medications were administered per physician orders. Audits will be done daily x 5 then weekly x4 then monthly x3 then quarterly or until 100% compliance is achieved. Results will be presented in QAPI committee meeting.
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