| 74 |
NASHVILLE COMMUNITY CARE & REHABILITATION AT BORDE |
445033 |
1414 COUNTY HOSPITAL RD |
NASHVILLE |
TN |
37218 |
2017-06-13 |
176 |
E |
0 |
1 |
PJSZ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation, and interview, the facility failed to determine if it was clinically appropriate for 3 of 3 (Resident #99,146 and 178) sampled residents reviewed were assessed to self-administer medications or had an order to self administer medications. The findings included: 1. The facility's Medication Administration General Guidelines policy documented, .Residents are allowed to self-administer medications when specifically authorized by the prescriber, the nursing care center's Interdisciplinary Team .and in accordance with procedures for self-administration of medications . The facility's Medication Administration Nebulizers documented, .remain with the resident for the treatment unless the resident has been assessed and authorized to self-administer . The facility's SELF-ADMINISTRATION BY RESIDENT policy documented, .Residents who desire to self-administer medications are permitted to do so with a prescriber's order and if the nursing care center's interdisciplinary team has determined that the practice would be safe .The interdisciplinary team determines the resident's ability to self-administer medications by means of a skill assessment conducted as part of the care plan process . 2. Medical record review revealed Resident #99 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. Observations in Resident #99's room, on 6/13/17 at 9:45 AM, revealed LPN #7 dispensed [MEDICATION NAME] medication into a nebulizer cup. increased the oxygen level to administer the treatment, put the nebulizer mask on Resident #99, left the room and went to another hall. There was no assessment or physician order [REDACTED]. 3. Medical record review revealed Resident #146 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The admission Minimum Data Set ((MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 8, indicating moderate cognitive impairment, and required extensive to total staff assistance for all activities of daily living. The care plan dated 3/20/17 documented, .Behavior .Problem .6/5/17 .Socially inappropriate .Resists Care .False Claims against staff .yelling out for caregivers continuously .Delusions . There was no documentation for self administration of medications. The physician's orders [REDACTED].[MEDICATION NAME] 20% (PERCENT) VIAL .One vial via nebulization four times a day .[MEDICATION NAME] .1 VIAL PER NEBULIZER FOUR TIMES DAILY . A telephone physician's orders [REDACTED].Add Dx's (diagnosis) of [MEDICAL CONDITION] . There was no assessment or physician order [REDACTED]. Observations in Resident #146's room on 6/11/17 beginning at 10:20 AM, revealed Resident #146 lying in bed holding a nebulizer medication cup in his hand containing clear liquid that was disconnected from the nebulizer. The nebulizer mask was around Resident #146's neck, and the nebulizer was turned on. The resident was yelling out for help, and was not able to state his name. There was no staff member in the room. 4. Medical record review revealed Resident #178 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. The quarterly Minimum Data Set ((MDS) dated [DATE] documented Resident #178 was severely cognitively impaired per staff assessment, and was totally dependent on staff for ADLs. The care plan dated 8/23/16, and last revised on 5/11/17, revealed there was no documentation for self administration of medications. The physician's orders [REDACTED].[MEDICATION NAME]/[MEDICATION NAME] SULFATE .1 VIAL PER NEBULIZER EVERY 6 HOURS . Observations in Resident #178's room on 6/11/17 beginning at 10:16 AM, revealed Resident #178 lying in bed with a nebulizer treatment in progress with the mask strapped to the resident's face. There were no staff member in the room. There was no assessment or physician order [REDACTED]. Interview with the Director of Nursing (DON) on 6/14/17 at 10:20 AM, in the conference room, the DON was asked whether there were any residents in the facility that could self-administer medications. The DON stated, No. The DON was asked whether it was appropriate for the nurse to start a nebulizer breathing treatment on a resident and then leave the resident alone. The DON stated, Well, the nurse is supposed to keep a frequent check on the residents. |
2020-09-01 |