| 26 |
GREENBRIAR HEALTHCARE |
305005 |
55 HARRIS ROAD |
NASHUA |
NH |
3062 |
2019-10-28 |
658 |
E |
0 |
1 |
TYS711 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, it was determined that the facility failed to meet professional standards for medication administrations via a Gastrostomy tube ([DEVICE]), and checking patency for a Peripherally Inserted Central Catheter (PICC) line prior to medication administrations for 2 out of 37 medication administrations observed; and 2 medication omissions noted on record review for 3 resident out of final sample size of 35 residents. (Resident identifiers are #22, #39, and #46.) Findings include: Resident #46 Wolters Kluwer Health (edited by [NAME] M. Nettina), Manual of Nursing Practice. 9th ed. Ambler, Pennsylvania: Lippincott[NAME] and Wilkins, 2010. Page 86 .Types of I.V. (Intravenous) Administration . .Precaution and Recommendations . .1. Before medication administration . .f. Assess patency of the I.V. line by the presence of blood return . Observation on 10/23/19 at 2:05 p.m. with Staff A (Unit Manager) during medication administration for Resident #46's Meropenem (antibiotic) revealed that Staff A cleaned Resident #46's needleless connector of the PICC line with an alcohol wipe then waited for needless connector to air dry. Staff A used a 10 ml (milliliter) Normal Saline Flush to flush the needless connector. Staff A was not observed to have aspirated the PICC line catheter and no red blood-like substance was observed when Staff A flushed Resident #46's PICC line catheter. Staff A then proceeded to administer Meropenem 1 Gm (gram) I.V. Review on 10/24/19 of facility's procedure titled, Central Vascular Access Device ([MEDICAL CONDITION]) Flushing and Locking, revision dated 5/1/2016, revealed that .[MEDICAL CONDITION] .considerations .1.1 Peripherally Inserted Central Catheter (PICC) .flushing/locking (sic) is performed to ensure and maintain catheter patency .5. Catheter patency must be verified prior to each access. To assess patency, aspirate catheter to obtain a positive blood return. The aspirated blood should be the color and consistency of whole blood .Procedure: .9. Attach syringe with prescribed flushing agent to needleless connector. Aspirate the catheter to obtain blood return to verify vascular access patency . Interview on 10/24/19 at 9:10 a.m. with Staff A confirmed above observation. Staff A stated that when they flush Resident #46's PICC line catheter with 10 ml Normal Saline there was no resistance which indicated that the PICC line was patent. Staff A was unable to state facility's procedure in checking patency of a PICC line. Resident #22 Interview on 10/23/19 at 9:58 a.m. with Resident #22 revealed that the resident had a concern with medication administration. Resident #22 stated; I am very independent. The staff here help me with showers and they give me my medications. There is always a problem with my medications. Often times I get the wrong ones or some meds are missing and I make them take back the meds and get me the right ones. My inhalers have been unavailable for weeks at a time. Review on 10/25/19 at 12:30 p.m. of Resident #22's nursing notes and MAR (Medication Administration Record) revealed that on the following dates, medication that was ordered was not administered: 10/4/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID (twice per day). Reason Missed: Waiting for Pharmacy to deliver. Signed by Staff H, (licensed Practical Nurse), LPN. 10/5/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason Missed: Medication is unavailable. Signed by Staff H. 10/6/19: [MEDICATION NAME] Tablet 40 mg, 4 tabs PO (by mouth) QD (once per day). Reason not given: Unavailable. Signed by Staff [NAME] 10/6/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Medication unavailable. Signed by Staff [NAME] 10/7/19: Note text: [MEDICATION NAME] Tablet 50 mg, give 4 tablets PO QD for tremors. (Not given): Med ordered but has not been delivered by pharmacy, nurse called pharmacy and according to pharmacy, resident is still hospitalized in their computing system but informed patient has been discharged and is in the facility. Signed by Staff G, LPN 10/7/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff PO BID. (Not given): Med ordered but has not been delivered by pharmacy, nurse called pharmacy and according to pharmacy, resident is still hospitalized in their computing system but informed patient has been discharged and is in the facility. Signed by Staff [NAME] 10/16/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Awaiting Delivery. Signed by Staff [NAME] 10/20/19: [MEDICATION NAME] Diskus Aerosol Powder 1 Puff BID. Reason not given: Pending delivery from the pharmacy. Signed by Staff F, RN. Review of Resident #22's medical record on 10/28/19 at approximately 12:55 pm revealed that there were no notes to the physician to communicate that these medications were missed, and how to proceed. Interview on 10/28/19 at approximately 1:15 p.m. with Staff B Director of Nursing (DON) confirmed that Resident #22's record did not have documentation to support that the physician had been informed of the missed medications, or how to proceed. Staff B could not provide rationale for the missed medications, for not notifying the physician of the missed medications, or administering staff not inquiring of the physician as to how to proceed. Record review on 10/28/19 at approximately 1:45 p.m. after Staff B provided a printed Order-Search of Omnicare Pharmacy Delivery records dated from 10/1/19 to 10/28/19 revealed the following information for Resident #22's [MEDICATION NAME] and [MEDICATION NAME] medication deliveries: 10/8/19: [MEDICATION NAME] Diskus Delivered on 10/8/19 at 3:09 a.m. 10/8/19: [MEDICATION NAME] 50 mg Delivered on 10/8/19 at 3:09 a.m. 10/18/19: [MEDICATION NAME] Diskus Delivered on 10/18/19 at 7:44 p.m. Resident #39 [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Page 708 The prescriber often gives specific instructions about when to administer a medication Observation on 10/24/19 at approximately 9:30 a.m. of Resident #39's Gastrostomy tube medication administration with Staff J (Licensed Practical Nurse) revealed that during the administration of 8 medications the tube was not flushed in between medications. Medications administered: Atorvastatin 10 milligrams Calcium with Vitamin D 600-400 milligrams [MEDICATION NAME] 25/100 milligrams Vitamin B12 1000 milligrams [MEDICATION NAME] HCL ([MEDICATION NAME]) 500 milligrams Buproprian HCL 100 milligrams Sodium Chloride 1 gram [MEDICATION NAME] Acid 250 milligrams- 5 milliliters (15 milliliters) Review on 10/24/19 of Resident #39's Medication Administration Record [REDACTED] Flush tube with 5 ml's (milliliters) of water between each medication. Interview on 10/24/19 at at approximately 9:40 a.m. with Staff J confirmed that there were no water flushes administered in between the 8 medications. Review on 10/25/19 of the facility's policy and procedure titled, 6.0 General Dose Preparation and Medication Administration, Revision date; 12/1/07 revealed: .Procedure . 4.1.1 Verify each time a medication is administered that it is the correct medication, at the correct dose, at the correct route, at the correct rate . |
2020-09-01 |