| 2135 |
BEDFORD HILLS CENTER |
305060 |
30 COLBY COURT |
BEDFORD |
NH |
3110 |
2011-02-17 |
465 |
D |
|
|
BGE911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview it was determined that the facility failed to provide a safe environment for residents and staff regarding the handling of a non-crushable medication for 1 resident in a survey sample of 24 residents. (Resident identifier is Resident #6.) Findings include: Standard: Mosby's Medical Dictionary, 8th edition. ? 2009, Elsevier. "[MEDICATION NAME], an immunosuppressant used to prevent rejection of allogeneic cardiac, hepatic, and renal transplants. It is administered orally or intravenously." "indications It is used to prevent rejection of organ transplants and for [MEDICATION NAME] of organ rejection in allogenic cardiac transplants. contraindications Known hypersensitivity to this drug or to [MEDICATION NAME] acid prohibits its use. adverse effects Life-threatening effects are leukopenia, [MEDICAL CONDITIONS], pancytopenia, renal tubular necrosis, and [MEDICAL CONDITION]. Other adverse effects are arthralgia, muscle wasting, and stomatitis. Common side effects are diarrhea, constipation, nausea, vomiting, rash, dyspnea, respiratory infection, increased cough, pharyngitis, [MEDICAL CONDITION], pneumonia, tremor, dizziness, [MEDICAL CONDITION], headache, fever, peripheral [MEDICAL CONDITIONS], [MEDICATION NAME], [MEDICAL CONDITIONS], hypokalemia, [MEDICAL CONDITION], urinary tract infection, hematuria, hypertension, chest pain, and nonmelanoma skin [MEDICAL CONDITION]." Nursing Spectrum Drug Handbook 2009. ? 2009 by The McGraw-Hill Companies, Inc. "Administration ... Give P.O. form at least 1 hour before or 2 hours after meals. To enhance absorption, don't give with other drugs. Give delayed-released tablets whole. Don't let patient crush or chew them. Know that pharmacist should mix oral solution before dispensing." "Be aware that drug is teratogenic. Avoid inhaling powder in capsules or letting powder contact skin, mucous membranes, or eyes. If contact occurs, wash skin thoroughly with soap and water or flush eyes with water. Know that delayed-release tablets aren't interchangeable with immediate-release tablets, capsules, or oral suspension." Resident #6. Record review for Resident #6 was conducted 2/15/11 - 2/17/11. Review of the facility Physician order [REDACTED]." Review of this resident's Medication Administration Record dated 2/1/11 - 2/28/11 revealed an order for [REDACTED]." Observation on 2/16/11 at 8 a.m. during the medication pass revealed a "bingo style" medication administration card for "[MEDICATION NAME] ([MEDICATION NAME]) 500 MG TABLET 1 tab via G- Tube twice a day..." Observation revealed a pharmacy warning label that read, "Medication has boxed warning; Don't chew/crush- swallow whole... " The card had 4 pills missing. On 2/16/11 at the time of the observation with Staff D (Medication Nurse) the MAR dated 2/1/11 - 2/28/11 for Resident #6 was reviewed. Interview with Staff D revealed that staff had been crushing the above medication but Staff D had not noticed the warning. Staff D stated that this resident was on the liquid version of this medication at one time. Staff D did not crush the medication or give it. The physician was notified and the pharmacy sent the liquid for that afternoon. In an interview with Staff A (DON) on 2/16/11 in the afternoon Staff A confirmed the above findings and stated that the warning to not crush the medications was because of the possibility of harm to the staff. Staff A acknowledged that the ([MEDICATION NAME]) medication should not have been crushed. |
2014-04-01 |