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Based on observation, interview, record and policy review the facility failed to administer the drug (Megestrol 400 mg) in accordance with the orders of the practitioner and accepted standards of practice in 1 (SP#3) out of 4 sample patients (SP).

Findings include:

Review of sample patient (SP) #3 Medication Administration Flowsheet dated 03/05/2019 at 9:00AM revealed the following medications were ordered for administration: Amlodipine 5mg by mouth daily, Benztropine 1 mg(milligrams) by mouth two times a day, Cyanocobalamin 1000 mcg (microgram) by mouth daily, Gabapentin 100 mg by mouth daily, Megestrol 400 mg by mouth two times a day, Metoprolol 25 mg by mouth two times a day, Multivitamin 1 tablet by mouth daily, Olanzapine 10 mg by mouth two times a day

Review of SP#3 Medication Administration Flowsheet dated 03/05/2019 at 9:59 AM revealed that all the medications scheduled for the 9:00 AM administration was verified.

Medication administration observation for SP#3 was conducted with the Registered Nurse-Staff A on 03/05/2019 at 9:26 AM revealed staff A brought the computer on wheels into the medication room and verified medications to be administered prior to removing the medications from their storage areas. Staff removed ordered medications and brought the computer on wheels out of the medication room into an empty recreational room while instructing the patient to go into the room for medication administration. Staff B brought in the blood pressure cuff and then Staff A explained to the patient that medications will be given after the blood pressure was taken. Staff A scanned the identification band of SP#3 and placed all the medications in a soufflé cup. The soufflé cup and water was given to SP#3 and the patient placed the pills in mouth and drank the water. Staff A encouraged water and ensured medication was swallowed without difficulty. Staff A then provided a unit-dosed liquid medication (Megestrol 400mg) in which the patient poured into the cup of water, took one sip, and gave the cup to Staff A. Staff A then placed the cup with the diluted medication on the computer on wheels and then proceeded to scan all the medication as administered. Staff A then returned the computer on wheels to the medication room, disposed of the diluted medication and verbalized that the medication administration was completed. From the beginning to the completion of the medication administration procedure, Staff A was not observed performing any hand hygiene.

Interview with Chief Nursing Officer (CNO) and Assistant Chief Nursing Officer (ACNO) on 03/05/2019 at 10:20 AM revealed that ACNO stated Staff A informed ACNO that hand hygiene was performed prior to the medication administration. Stated that when a staff scans the medication after administration, the scanning verifies that the medication was administered.

Review of Policy Subject: "Medication Administration; Manual: Administrative; Department: Pharmacy/Nursing", (Revised: 02/12; Reviewed: 06/18); Procedure: B. Administration - 3. Prior to preparing medication for administration, healthcare professionals administering medication shall wash hands using proper technique. 10. Sign the Medication Administration list in the Electronic Medical Record (eMAR) and verify that administered medications display appropriately on the eMAR. 11. Wash hands again. C. Charting / Documentation - 1. Document administration of the medication on the eMAR. 3. Omitted medications: chart the "Not Given," the reason for omission, and actions taken.