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Based on observation, interview, record review, and review of the facility's policy/procedure, it was determined the facility failed to ensure drugs were prepared and administered in accordance with the orders of the practitioner responsible for the patient's care and accepted standards of practice for one (1) unsampled resident (Resident A).

The findings include:

Review of the Nursing Standard Operating Procedure "Medication Administration and Documentation", last revised January 2014, revealed medications were administered and documented by an authorized licensed nurse according to the seven (7) rights of medication administration. The "7 Rights of Medication" included the following: right patient, right medication, right dose, right route, right time, right reason, and right documentation.

Observation, on 04/09/14 at 2:20 PM, revealed Licensed Practical Nurse (LPN) #1 administered the following medication to Resident A:

1. Lithium 8 milliequivalents (meq) per 5 milliliter (ml) liquid (300 mg per 5 ml), 2.5 ml (150 mg) drawn up and administered using a 3 ml Monoject syringe.

Review of the Physician's Order, dated 03/28/14, revealed an order for Lithium liquid 200 mg by mouth three times daily.

Interview with LPN #1, on 03/09/14 at 2:35 PM, revealed the resident's order was for Lithium 200 mg liquid; however, she only administered 150 mg (2.5 ml).

Interview with the Physician, on 04/09/14 at 3:15 PM, revealed he expected staff to calculate and administer the resident's Lithium at the appropriate dose.

Interview with the Assistant Director of Nursing (ADON), on 04/09/14 at 3:26 PM, revealed she expected staff to give medications according to the facility policy.