HospitalInspections.org

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 of six (#2 and #6-#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, "Use of PRN Medications," with a revised date of 10/2021 showed the nurse who administered the PRN medication would document the purpose for which the medication was given and whether the patient's outcome was effective or ineffective in response to the medication. The policy did not state a time frame in which the outcome of the medication would be assessed.
B. The findings of A were confirmed in an interview with the Chief Nursing Officer on 04/12/22 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 #2's Medication Administration Record showed Atarax 50 mg (milligrams) to be administered every 6 hours PRN. Atarax was documented as given on 04/05/22 at 8:00 AM and 9:00 PM, on 04/06/22 at 8:00 AM and on 04/09/22 at 5:55 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 Chief Nursing Officer on 04/12/22 at 2:42 PM.
E. Review of Patient #6's Medication Administration Record showed the following:
1) Tylenol 650 mg to be administered every 6 hours PRN. Tylenol was documented as given on 04/08/22 at 9:45 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Tums 1000 mg to be administered every 12 hours PRN. Tums was documented as given on 04/08/22 at 1:50 PM and on 04/10/22 at 7:22 PM and 7:40 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 Chief Nursing Officer on 04/12/22 at 1:40 PM.
G. Review of Patient #7's Medication Administration Record showed the following:
1) Clonazepam 1 mg to be administered every 6 hours PRN. Clonazepam was documented as given on 04/06/22 at 5:50 PM, on 04/07/22 at 9:15 AM and 3:30 PM and on 04/08/22 at 7:30 AM and 1:55 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Zofran 4 mg to be administered before meals PRN. Zofran was documented as given on 04/11/22 at 4:42 PM and 1:48 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3) Atarax 100 mg to be administered every 6 hours PRN. Atarax was documented as given on 04/09/22 at 10:00 AM, on 04/10/22 at 7:20 AM, on 4:42 AM and 10:00 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
4) Atarax 100 mg to be administered every 4 hours PRN. Atarax was documented as given on 04/11/22 at 4:00 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 Chief Nursing Officer on 04/12/22 at 2:15 PM.
I. Review of Patient #8's Medication Administration Record showed the following:
1) Hydroxyzine 100 mg to be administered every 6 hours PRN. Hydroxyzine was documented as given on 04/07/22 at 4:00 AM and 2:40 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Tylenol #3 one tablet to be administered every 12 hours PRN. Tylenol #3 was documented as given on 04/10/22 at 5:40 PM and on 04/11/22 at 11:40 AM. 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 Chief Nursing Officer on 04/12/22 at 2:09 PM.
K. Review of Patient #9's Medication Administration Record showed the following:
1) Valium 10 mg to be administered every 6 hours PRN. Valium was documented as given on 04/05/22 at 8:00 PM, on 04/06/22 at 8:45 AM, 2:15 PM and 8:00 PM and on 04/07/22 at 7:30 AM and 5:30 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Ambien 10 mg to be administered every hour sleep PRN. Ambien was documented as given on 04/05/22 at 8:00 PM and on 04/06/22 at 8:00 PM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
3) Norco 5/325 mg to be administered every 6 hours PRN. Norco was documented as given on 04/07/22 at 5:31 PM, 04/09/22 at 8:46 AM and 4:22 PM, on 04/10/22 at 8:22 AM, 2:38 PM and 8:40 PM and on 04/11/22 at 8:30 AM and 3:45 PM. 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 Chief Nursing Officer on 04/12/22 at 2:28 PM.
M. Review of Patient #10's Medication Administration Record showed the following:
1) Clonazepam 0.5 mg to be administered every 6 hours PRN. Clonazepam was documented as given on 04/01/22 at 10:55 AM, on 04/02/22 at 1:30 AM, 10:30 AM, 4:30 PM and 11:10 PM, on 04/03/22 at 7:30 AM, 1:30 PM and 7:00 PM, on 04/04/22 at 7:30 AM and 2:00 PM, on 04/05/22 at 8:25 AM, on 04/06/22 at 7:00 AM and 8:00 PM, on 04/07/22 at 12:50 PM, on 04/08/22 at 7:57 AM and 3:12 PM, on 04/09/22 at 1:19 AM and 3:40 PM and on 04/11/22 at 12:16 AM and 8:00 AM. There was no evidence of the purpose for administering the medication and no evidence of the outcome of administering the medication.
2) Zyprexa Zydis 10 mg to be administered every 4 hours PRN. Zyprexa Zydis was documented as given on 04/01/22 at 1:00 AM and 12:20 PM, on 04/02/22 at 1:30 AM, 4:30 PM and 11:13 PM, on 04/03/22 at 7:30 AM and 1:30 PM, on 04/04/22 at 7:30 AM and 2:00 PM, on 04/05/22 at 12:30 PM, on 04/07/22 at 12:50 PM, on 04/08/22 at 7:57 AM, on 04/09/22 at 1:19 AM and 2:40 PM, on 04/10/22 at 5:30 AM and on 04/11/22 at 3:00 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 Chief Nursing Officer on 04/12/22 at 1:35 PM.

Based on personnel file review and interview, it was determined the Chief Nursing Officer did not possess a master's degree in psychiatric or mental health nursing or maintain on-going education in the care of the mentally ill. The failed practice did not ensure the Chief Nursing Officer was qualified to direct the nursing services provided by the facility. The failed practice had the likelihood to affect all patients in the facility. Findings follow:

A. Review of the Chief Nursing Officer's resume on 04/12/22 showed the Chief Nursing Officer possessed a Bachelor of Science in Nursing. There was no evidence provided the Chief Nursing Officer possessed a master's degree in psychiatric or mental health nursing. There was no evidence provided of on-going education in the care of the mentally ill.
B. The findings were confirmed in an interview with the Chief Nursing Officer on 04/12/22 at 2:30 PM.