HospitalInspections.org

Based on observation of 2 medication rooms, Policy and Procedures review, the facility failed to prepare and administer medications in accordance to their own policies and procedures. Failure to prepare and administer medications in accordance with policies and procedures may result in contaminated and/or expired medications being administered to the patients.
Findings:


1. Observation of the medication room on the Adult Unit on 09/13/10 at 9:30 AM revealed 5 prepoured patient medications in medication cups, ready to administer, stored on top of the counter in the medication room. These prepoured patient medications were observed in medication cups, and ready to administer with unidentified medications in these cups.

2. Observation of the medication room on Adolescent Unit on 09/13/10 at 10:30 AM revealed 3 prepoured patient medications in medication cups, ready to administer, stored on top of the counter. These prepoured patient medications were observed in medication cups, and ready to administer with unidentified medications in these cups.

3. Review of the facility's Policy and Procedures for Medication Administration revealed the following:
4.0 Procedure:
4.1 Nurses will remove unit doses of drugs and remove the seal of the drug and hand it to the patient with sufficient, suitable liquid to swallow the drug. The nurse may alternately place the oral drug into a medication cup and present that to the patient with suitable liquid.

Based on observation, record review and interview, the facility failed for seven of twenty (patient's #2, #4, #8, #9, #10, #16, #19) patients selected for review, to administer medications as prescribed by the physician. Failure to administer medications as prescribed has the potential for adverse drug reactions.

Findings:
1. Record review for patient # 2 revealed that she/he had an order dated 01/20/10 for Topamax 50 mg one tablet to be administered two times a day (BID) every morning at 9:00 AM and every afternoon at 5:00 PM.
Review of the Medication Administration Record (MAR) revealed that the Topamax one tablet had not been documented as administered from January 21st at 9:00 AM, and 5:00 PM, to January 26th, 2010. Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
2. Record review for patient # 4 revealed that she/he had an physician order for Thera Multivitamin one tablet to be administered one times a day (QD) every afternoon at 5:00 PM., Ativan 1 mg every afternoon at 5:00 PM, Geodon 20 mg to be administered at 10:00 AM, and Celexa 20 mg.
Review of the Medication Administration Record (MAR) revealed that the Thera Multivitamin one tablet and Ativan 1 mg at 5:00 PM had not been documented as administered on June 1st, 2010. Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
Further review of patient #4's MAR's revealed that the Geodon 20 mg and the Celexa 20 mg was not administered on March 22 nd, 2010 and the nurse's initialed with a note next to the initials that it was not given. Review of the medical record did not reveal that the physician was notified of the medication being unavailable.
3. Record review for Resident #8 revealed that she/he had an order for Depakote 100 mg. one capsule every morning at 9:00 AM and Imipramine 20 mg. one tablet to be administered (BID) every morning at 9:00 AM, and every afternoon at 1:00 PM.
Review of the Medication Administration Record (MAR) revealed that the Depakote 100 mg. and the Imipramine 20 mg. had not been administered on June 5th and 6th, 2010, as it was unavailable. It was documented on the front of the MAR that it was unavailable.
Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
4. Record review for Resident #9 revealed that she/he had an order for Miralax powder 17 grams to be mixed in 8 ounces of water, to be administered one time a day (QD), every evening at 9:00 PM.
Review of the Medication Administration Record (MAR) for July, 2010, revealed that the Miralax powder had not been administered on July 19th, through July 28th, 2010, at 9:00 PM, as it was unavailable. It was documented on the front of the MAR for these days that the medication was Not Available (N/A) and the nurse circled his/her initials.
Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
5. Record review for patient # 10 revealed that she/he had an order dated 08/27/10 for Amoxicillin 500 mg one tablet to be administered three times a day (TID) for seven (7) days every morning at 9:00 AM and every afternoon at 2:00 PM and at 5:00 PM.
Review of the Medication Administration Record (MAR) revealed that the one tablet had not been documented as administered from September 1st and 2nd, 2010 at 5:00 PM. Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
6. Record review for Resident #16 revealed that she/he had an order for Lipitor 10 mg. 1 tablet, to be administered one time a day (QD), every evening at 9:00 PM.
Review of the Medication Administration Record (MAR) for July, 2010, revealed that the Lipitor 10 mg one tablet had not been administered on July14th, 2010, at 9:00 PM, as it was unavailable. It was documented on the front of the MAR for these days that the medication was Not Available (N/A) and the nurse circled his/her initials.
Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
7. Record review for Resident #19 revealed that she/he had an order for Ambien 10 mg. 1 tablet, to be administered one time a day (QD), every evening at 9:00 PM.
Review of the Medication Administration Record (MAR) for July, 2010, revealed that the Ambien 10 mg one tablet had not been administered on July 21st, 2010, at 9:00 PM, as it was unavailable. It was documented on the front of the MAR for these days that the medication was Not Available (N/A) and the nurse circled his/her initials.
Further review of the medical record did not reveal that the physician was notified of the medication being unavailable.
8. Interview on 09/13/10 at 1:15 PM, with the Director of Nursing revealed that if nursing staff have a medication that is not available, and the pharmacy has not delivered after contacted, then the physician should be notified of the unavailability of the medication.