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Based on clinical record review, policy and procedure review and interview, it was determined the nursing staff failed to provide evidence of the purpose of administering PRN (as needed) medications and failed to provide evidence of the outcome of PRN medications for six (#1,4, #6, #7, #9-#10) of ten (#1-#10) patients who were given PRN medications. The failed practice did not ensure the medications were administered for the reason ordered and failed to ensure the medication was effective. The failed practice had the likelihood to affect all patients receiving PRN medications. Findings follow:

A. Review of the facility's policy titled, "Documentation-Nursing," revised 09/01/20, showed the nursing process used in the delivery of patient care with the documentation of the effectiveness or outcomes of nursing interventions and the patient's response.
B. The findings of A were confirmed in an interview with the Chief Nursing Officer on 05/10/2022 at 2:10 PM. The Chief Nursing Officer stated the time frame in which the outcome of the medication would be assessed was generally between 30 minutes to 1 hour after giving the PRN medication.
C. Review of Patient #1's Medication Administration Record showed the following:
1) Ondansetron 4 mg(milligrams) to be administered IVP(Intravenously). Ondansetron was documented as given on 10/06/21 at 10:27 AM and at 12:59 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Morphine 4mg was to be administered IVP. Morphine was documented as given on 10/06/21 at 10:28 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3) Labetalol 10 mg to be administered IVP. Labetalol 10 mg was documented as given on 10/06/21 at 10:28 AM and at 10:55 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
4) Labetalol 200 mg to be administered orally. Labetalol 200 mg was documented as given on 10/06/21 at 12:59 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
5) Dilaudid 1mg to be administered IVP Dilaudid was documented as given on 10/06/21 at 1:00 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
D. The findings of C were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 8:45 AM.

E. Review of Patient #4's Medication Administration Record showed the following:
1) Diazepam 5 mg to be administered IVP. Diazepam was documented as given on 10/05/21 at 7:59 PM and at 8:56 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Fentanyl 50 mcg (Micrograms) was to be administered IVP. Fentanyl Morphine was documented as given on 10/05/21 at 9:20 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3) Ondansetron 4 mg to be administered IVP. Ondansetron was documented as given on 10/05/21 at 10:05 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
4) Morphine 4mg was to be administered IVP. Morphine was documented as given on 10/05/21 at 10:05 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
F. The findings of E were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 8:50 AM.
G. Review of Patient #6's Medication Administration Record showed the following:
1) Labetalol 20 mg to be administered IVP. Labetalol 20 mg was documented as given on 05/03/22 at 7:25 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication
2) Labetalol 10 mg to be administered IVP. Labetalol 10 mg was documented as given on 05/03/22 at 8:19 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3) Morphine 4mg was to be administered IVP. Morphine was documented as given on 05/03/22 at 8:20 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
4) Ondansetron 4 mg to be administered IVP. Ondansetron was documented as given on 05/03/22 at 8:20 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
5) Zyrtec 10 mg to be administered orally. Zyrtec was documented as given on 05/03/22 at 10:53 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
H. The findings of G were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 9:00 AM.
I. Review of Patient #7's Medication Administration Record showed the following:
1) Ondansetron 4 mg to be administered IVP. Ondansetron was documented as given on 10/05/21 at 10:05 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Morphine 4mg was to be administered IVP. Morphine was documented as given on 05/04/22 at 4:33 PM and 7:56 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
J. The findings of I were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 9:15AM.
K. Review of Patient #9's Medication Administration Record showed Lisinopril 10 mg to be administered orally. Lisinopril was documented as given on 05/08/22 at 12:11 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
L. The findings of K were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 9:20AM.
M. Review of Patient #10's Medication Administration Record showed the following:
1) Ondansetron 4 mg to be administered IVP. Ondansetron was documented as given on 05/02/22 at 7:44 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Protonix 40 mg to be administered IVP. Protonix was documented as given on 05/02/22 at 7:45 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3)Toradol 30 mg to be administered IVP. Toradol was documented as given on 05/02/22 at 7:45 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
N. The findings of M were confirmed in an interview with the Emergency Resource Nurse on 05/10/22 at 9:30AM.