| 4851 |
SIDNEY CARE AND REHABILITATION CENTER, LLC |
285113 |
1435 TOLEDO STREET |
SIDNEY |
NE |
69162 |
2018-03-06 |
755 |
H |
1 |
1 |
9WK311 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.12A Based on record reviews and interviews, the facility failed to ensure that medications were available to administer as ordered 1) on admission for two current sampled residents (Residents 176 and 175), 2) for an antifungal medication to treat a skin disorder for one current sampled resident (Resident 20) and 3) for antibiotics to treat a urinary tract infection for one current sampled resident (Resident 24). The facility census was 27 with 16 current sampled residents. Findings are: [NAME] Review of the Admission Record revealed that Resident 176 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Medication Administration Record, dated (MONTH) (YEAR), revealed that the following medications were not administered as ordered on admission: - [MEDICATION NAME] daily for Major [MEDICAL CONDITION], start date 2/24/18 and not administered until 2/25/18; - [MEDICATION NAME] Ointment apply daily to wound on upper back, start date 2/24/18 and not applied until 2/25/18; - [MEDICATION NAME] tapering doses, two times a day for Malignant Neoplasm of Brain and Cerebral [MEDICAL CONDITION] (swelling), ordered 2/23/18 and not administered until 2/25/18; - [MEDICATION NAME] every four hours as needed for pain, ordered 2/23/18 and not administered until 2/26/18; - [MEDICATION NAME] every four hours as needed for pain, ordered 2/23/18 and not administered until 2/27/18. Review of the hospital emergency room report, dated 2/25/18 at 12:56 AM, revealed the following including: - Final Impression: Headaches and reported shoulder dislocation; - Differential Diagnosis: [REDACTED]. Examination showed that the patient has difficulty understanding and following commands at this time, spouse reports that since the [MEDICAL CONDITION] the patient has times periods of being alert and oriented and answers questions to period where the patient cannot follow commands, respond well, can't answer questions. The patient acts like is trying to answer but is unable to get the words out. - Presenting problems included history of [MEDICAL CONDITION] and brain surgery on 2/12/18, spouse received a call from the nursing home that the resident was having severe pain in the left shoulder, found that the left shoulder was dislocated, and left hand was blue, spouse reduced the left shoulder and restored circulation to the left arm. The dislocation may have occurred while trying to assist the patient off of the toilet. The spouse reported that the resident had not received the ordered doses of steroid since admission to the facility for cerebral [MEDICAL CONDITION] (brain swelling) prevention and was increasingly lethargic and sleeping much more than normal, 18 hours today. The resident was given a dose of steroid and orders for tapering doses. Interview with the resident's spouse on 2/28/18 at 7:45 AM revealed concerns related to pain management. The spouse stated that the resident has a long history of frequent headaches since diagnosed wih the [DIAGNOSES REDACTED] and typically took Tylenol at least a couple of times a day for lesser pain and [MEDICATION NAME] daily for more severe headaches. The spouse was concerned that the resident was having pain and medications were not being administered when needed. The spouse also stated concerns related to the missed doses of the steroid ordered on admission which may have contributed to the increased lethargy sleeping all day on 2/24/18 and being so out of it on 2/25/18. Interview with the Nurse Consultant on 2/28/18 at 3:00 PM confirmed that the resident's medications listed above were not received from the pharmacy on admission and were not administered until available as documented on the Medication Administration Record. B. Review of the Admission Record revealed that Resident 175 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Medication Administration Record, dated (MONTH) (YEAR), revealed that the following medications were not administered as ordered: - [MEDICATION NAME], ordered on [DATE] every evening for Diabetes, not administered until 2/20/18; - Latanoprost eye drops to both eyes for [MEDICAL CONDITION], ordered 2/18/18 and not administered until 2/21/18; - Terozosin every bedtime related to [MEDICAL CONDITION], ordered 2/18/18 and not administered until 2/20/18; - [MEDICATION NAME] daily for [MEDICAL CONDITION] Fibrillation, ordered 2/19/18 and not administered until 2/20/18; - [MEDICATION NAME] two times a day for Partial Intestinal Obstruction, ordered on [DATE] and not administered until evening dose on 2/20/18; - [MEDICATION NAME] ordered two times a day for Diabetes, ordered 2/19/18 and not administered until 2/20/18; - Potassium Chloride ordered two times a day, ordered 2/18/18 and not administered until evening dose on 2/20/18; - Risamine ointment to reddened groin two times a day, ordered 2/18/18 and not applied until the evening dose on 2/20/18; - [MEDICATION NAME] R injections per sliding scale four times a day for Diabetes, ordered 2/18/19 and not administered until 2/20/18. Interview with the Director of Nursing on 3/5/18 at 9:40 AM confirmed that the medications listed above were not received from the pharmacy on admission and were not administered as ordered until available as documented on the Medication Administration Record. C. Review of Resident 20's Medication Administration Record, dated (MONTH) (YEAR), revealed an order, dated 2/10/18, for [MEDICATION NAME] (antifungal) daily for [DIAGNOSES REDACTED] (reddened and chaffing skin) which was not administered on 2/10/18, 2/11/18 and 2/12/18. Further review revealed an order, dated 2/13/18, for [MEDICATION NAME] daily for until 2/20/18 which was not given 2/13/18 through 2/16/18. [MEDICATION NAME] was ordered again on 2/17/18 to be administered daily until 2/23/18. Further review revealed that it was administered daily as ordered on [DATE] through 2/23/18. Interview with the Nurse Consultant on 3/5/18 at 3:00 PM confirmed that there was a mix up with the pharmacy orders and the medication was not available until 2/17/18. Further interview confirmed that the resident's were to receive their medications as ordered which did not occur due to issues with the pharmacy and staff not following the procedures for ordering medications for the residents. D. Record review of Resident 24's Admission Record printed on 2/28/18 revealed the resident was initially admitted to the facility on [DATE]. Among the medical [DIAGNOSES REDACTED]. Record review of Resident 24's Progress Notes revealed the following entries: - 2/13/2018 at 5:34 p.m. LPN (Licensed Practical Nurse)-C recorded: Received new orders for UTI (Urinary Tract Infection). [MEDICATION NAME] (antibiotic) 100 mg (milligrams) 2 x (two times) day for 7 days . - 2/14/2018 at 7:38 a.m. MA (Medication Aide)-F recorded the [MEDICATION NAME] was not given due to on order. - 2/15/18 at 4:44 p.m. LPN-D recorded the [MEDICATION NAME] was not given due to waiting to be delivered. - 2/16/18 at 11:59 p.m. LPN-D recorded the [MEDICATION NAME] was not given to the resident due to waiting for delieery (sic for delivery). - 2/16/18 at 1:55 p.m. LPN-D recorded: [MEDICATION NAME] 100 mg first dose started today for UTI. Record review of Resident 24's Medication Administration Record for (MONTH) of (YEAR) revealed [MEDICATION NAME] 100mg was ordered on [DATE] with instructions to administer the medication twice a day for Urinary Tract Infection. Further review of the document revealed the medication was not administered to the resident until 5:30 p.m. on 2/16/18 revealing that five potential doses of the medication were delayed from being administered to the resident as ordered. Interview with the Director of Nursing on 3/5/18 at 3:00 p.m. confirmed Resident 24 was ordered [MEDICATION NAME] on 2/14/18 for a urinary tract infection and the medication was not administered to the resident until 5:30 p.m. on 2/16/18. |
2020-03-01 |