|§ 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 and select facility policy and staff interview, it was determined that the facility failed to provide nursing services consistent with professional standards by failed to administer medications timely as scheduled and/or prescribed for two residents out of six sampled (Resident 62 and 78).
A review of a facility policy for administering medications, dated as reviewed by the facility April 2022, revealed that, medications are administered in a safe and timely manner and as prescribed. Medications are administered in accordance with prescriber orders, including any required time frame. Medications are administered within one hour of their prescribed time, unless otherwise specified (for example, before and after meal orders).
Clinical record review revealed that Resident 78 was admitted to the facility on July 15, 2017 with diagnoses to include dementia and hypertension.
The resident had a physician orders dated December 28, 2021, Lopressor Tablet 50 MG (Metoprolol Tartrate - an antihypertensive medication), Give 50 mg by mouth two times a day for hypertension, give with food. The resident's May 2022 medication administration record (MAR) indicted that the medication was to be given at 8 AM and 4 PM.
Pharmacy documentation indicated that on May 17, 2022, Employee 1, LPN, administered Lopressor 50 mg to Resident 78 at 10:02 AM. Facility documentation indicated that the breakfast meal was delivered to the resident at approximately 8 AM that morning.
Employee 1 failed to administer the resident's medication with food as prescribed, and as scheduled at 8 AM.
A review of the clinical record revealed that Resident 62 was admitted to the facility on May 6, 2016 with diagnosis to include diabetes and depression.
Resident 62 had a physician order dated August 5, 2021, Metformin HCL ( a diabetic medication ) 1000 mg by mouth once a day for diabetes, give with breakfast. The resident's May 2022 MAR indicted that the medication was scheduled to be given at 8 AM.
Pharmacy documentation indicated that on May 17, 2022, Employee 1 administered metformin 1000 mg to Resident 62's at 10:36 AM.
Resident 62 also had a physician order dated December 28, 2021, for Glimepiride ( a diabetic medication ) 4 mg by mouth once a day for diabetes, give with breakfast. According to the resident's May 2022 MAR indicated that the medication was scheduled for administration at 8 AM.
Pharmacy documentation indicated that on May 17, 2022, Employee 1 administered Glimepiride 4 mg to Resident 62 at 10:36 AM by Employee 1 (LPN).
Facility documentation indicated that the breakfast meal was delivered to the resident at approximately 8 AM.
Employee 1 failed to administer the resident's diabetic medications with food as prescribed and scheduled at 8 AM.
The resident had a physician order dated April 15, 2022, Zoloft, 175 mg ( an antidepressant medication) by mouth once a day for depression. The May 2022 medication administration record (MAR) indicted that the medication is to be given at 9 AM.
Pharmacy documentation indicated that on May 17, 2022, Employee 1 administered Zoloft 175 mg to the resident at 10:36 AM.
During an interview May 31, 2022 at approximately 12 PM, the Director of Nursing confirmed that Employee 1 failed to administer medications timely and as ordered for Resident 78 and 62.
28 Pa. Code 211.12 (a)(c)(d)(1)(3)(5) Nursing Services
28 Pa. Code 211.10(a)(c) Resident care policies
| ||Plan of Correction - To be completed: 07/05/2022|
Resident 62 and 78 medications are given as prescribed and within one hour of the prescribed times. Upon employee 1's return from suspension, the facilities Corporate Educator and Pharmacy consultant have provided re-education on the facilities Medication Administration policy. Additionally, supervised med passes are being conducted, with random audits ongoing, for employee 1.
Current resident's medications are given as prescribed and within one hour of the prescribed times.
Appropriate nursing staff have been re-educated on the importance of giving mediation as prescribed and within one hour of the prescribed times. The facilities Medication Administration policy will be reviewed with appropriate nursing staff. Appropriate nursing staff will demonstrate a mock medication pass to ensure full competency of medication administration per policy.
DON/Designee will audit medication administration, and PCC reports, to ensure compliance.