| 85 |
LAS VEGAS POST ACUTE & REHABILITATION |
295006 |
2832 S. MARYLAND PARKWAY |
LAS VEGAS |
NV |
89109 |
2018-05-11 |
658 |
D |
0 |
1 |
QB3511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to clarify physician orders [REDACTED].#8), and 1 unsampled resident (Resident #6). Findings include: The facility policy and procedure titled Crushing Medications, revised 11/11, indicated medications would be crushed only when consistent with physician's orders [REDACTED]. The nursing staff or Consultant Pharmacist would notify any attending physician who gives an to order to crush a drug that the manufacturer states hould not be crushed (for example, long acting or [MEDICATION NAME] coated medication). The attending physician or Consultant Pharmacist must identify an alternative, or the attending physici8an must document why crushing the medication would not adversely affect the resident. Resident #8 Resident #8 was admitted on [DATE] with [DIAGNOSES REDACTED]. On 05/10/18 at 08:08 AM, the Licensed Practical Nurse (LPN) administered the following oral medication tablets crushed and then mixed with applesauce to the resident: [MEDICATION NAME] 50 milligrams (mg) Levitiracetam 250 mg and Chewable aspirin 81 mg. The record lacked a physician's orders [REDACTED]. There was no documentation on the Medication Administration Record (MAR) why it was necessary to crush the medication. On 05/10/18 at 08:42 AM, the LPN revealed the medications were crushed because the resident was unable to safely swallow whole pills or tablets. The LPN verified the record and MAR lacked a physician's orders [REDACTED]. The LPN stated she wasn't sure if a physician's orders [REDACTED]. The LPN stated nursing staff discussed which resident's needed crushed medications during change of shift meetings. Resident #6: The resident was admitted on [DATE] with [DIAGNOSES REDACTED]. 05/10/18 at 08:46 AM, the Registered Nurse (RN), administered the following oral medications crushed and mixed with pudding to the resident: [MEDICATION NAME] 10 mg 81 mg aspirin chewable [MEDICATION NAME] 20 mg [MEDICATION NAME] 1 1/2 tabs 37.5 mg [MEDICATION NAME] ER (extended release) 60 mg Nudexta 20 mg [MEDICATION NAME] 20 mg The record lacked a physician's orders [REDACTED]. There was no documentation on the Medication Administration Record (MAR) why it was necessary to crush the medication. On 05/10/18, in the morning, the RN verified the resident's record and MAR lacked a physician's orders [REDACTED]. She agreed there was no order to crush but there should be an order. Staff nurses just started crushing the resident's medication. A staff member told the RN to crush the medication for this resident because of difficulty swallowing the whole pills or capsules. The RN stated the [MEDICATION NAME] ER was extended release tabalet and should not be crushed, because the medication had the potential to release too fast with possible adverse effect. The RN acknowledged she had not noticed or acted on her knowledge regarding this medication. On 05/10/18 at 10:45 AM Director of Nursing (DON) reviewed physician orders [REDACTED]. The DON stated the procedure when medications needed to be crushed was to get a pharmacist review to see if any medications were not crushable and give advice on substitution medications which could be safely crushed. The DON stated the facility had a list of medications which should not be crushed, and a copy of the list was kept on each medication cart for the nurses to access easily. On 05/10/18, in the morning, a check of three medication carts revealed the list of medications which should not be crushed was not kept on the carts. Three different licensed nurses thought the list was included in the same book which held the MARs kept on top of each cart, however when they looked for the list it was not located. On 05/10/18 at 02:45 PM, the Consultant Pharmacist (CP) stated [MEDICATION NAME] ER tablet should never be crushed, because the medication was designed to be released slowly. If crushed, the medication could enter the resident's blood stream faster than desired and cause the blood pressure to go too low, which could be unsafe. Following administration of a [MEDICATION NAME] ER tablet which was inadvertantly crushed, the resident should be monitored for low blood pressure. The CP reported a physician's orders [REDACTED]. The CP stated stated the procedure when medications needed to be crushed was to request a pharmacist review to see if any medications were not crushable, and the pharmacist was to give advice on substitution medications which could be safely crushed and which could not. The CP reported they had furnished a list of medications which should not be crushed via a web-site communication tool. The CP revealed a copy of the list should be kept readily available. The CP stated they were not asked to review the medications for the resident in regards to crushing the medications for the resident, but this should have been done. On 05/10/18 at 03:05 PM, the DON revealed a copy of the list of medications which should not be crushed could not be located, but she would ask the CP to send her another one immediately. The DON did not know why orders were not obtained to crush the medications for Resdident #8, or the other resident. The DON stated it was the responsibility of nursing staff to clarify medication orders. The DON state it was her responsibility to ensure adequate medication regimen reviews were carried out by the CP. |
2020-09-01 |