§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.
|
Observations:
Based on clinical record review, and staff interviews it was determined that the facility failed to provide pharmaceutical services to assure the accurate acquiring, receiving, dispensing, and administration of drugs to meet the needs of each resident for one of 6 residents reviewed (Resident 4).
Findings include:
Review of Resident 4's clinical record revealed diagnoses that included: Parkinson's Disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow imprecise movement), hypertension (high blood pressure), and depression (feelings of severe despondency and dejection).
Further clinical record review revealed Resident 4 was admitted to the facility on February 20, 2024.
Review of Resident 4's physician orders, medication administration record and progress notes revealed the following medications weren't administered on the following dates and times: Carbidopa-Levodopa Oral Tablet 25-100 MG, 1 tablet by mouth four times a day (scheduled to be administered 7:30 AM, 11:30 AM, 4:30 PM, 9:30 PM and as needed) for Parkinson's, ordered on February 20, 2024, to start February 20, 2024. The medication was documented as administered on February 20, 2024 at 9:30 PM, however the subsequent dose on February 21, 2024 at 7:30 AM wasn't administered and was documented as pending pharmacy delivery; Carvedilol Oral Tablet 6.25 MG, 6.25 mg two times a day (scheduled to be administered 8:00 AM and 8:00 PM) for hypertension, ordered February 20, 2024, to start February 20, 2024. The medication was documented as not administered February 20, 2024, at 8:00 PM due to pending pharmacy delivery; and Mirtazapine Oral Tablet Disintegrating 15 mg by mouth one time a day (scheduled to be administered 8:00 PM) for depression, ordered on February 20, 2024, to start February 20, 2024. The medication was documented as not administered on February 20, 2024, at 8:00 PM due to pending pharmacy delivery.
Review of the facility's stocked medications in Omnicell (on-site automated system for medication storage and dispensing) revealed it included the following medications: Mirtazapine (medication used to treat depression) 7.5 milligrams (mg-unit of measure); carvedilol (medication use to treat hypertension) 3.125 mg; and carbidopa-levodopa (medication used to treat Parkinson's) 25-100mg tablet.
The facility failed to administer the aforementioned medications to Resident 4 that were available in the Omnicell.
During an interview with the Nursing Home Administrator on March 7, 2024, at 2:00 PM it was revealed that the aforementioned medications should have been administered to Resident 4 utilizing the Omnicell stock.
28 Pa. Code 211.9(1) Pharmacy services.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
| | Plan of Correction - To be completed: 04/16/2024
1.) Facility cannot retroactively fix the pharmacy delay for resident 4.
2.) Licensed staff are following the facility's guidelines and current residents are receiving ordered medication and notifying physicians if not available for guidance. A Comprehensive review of all new admissions within the last 30 days will be completed to ensure all medications were available and given.
3.) The Director of Nursing/designee will educate licensed staff on F-0755 Pharmacy Services, facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement. The Director of Nursing/designee will also educate licensed staff on the facility protocol of obtaining the medications through Omni cell or utilizing the 24 hour pharmacy service through the agreement with Omnicare.
4.) Director of Nursing/designee will audit new admissions weekly x4 to ensure they receive ordered medication and also to ensure they are available in a timely manner. Audit results will be reported to the Quality Assurance Performance Improvement Committee for further review and recommendation.
|
|