| 4548 |
MINNIE HAMILTON HEALTH CARE |
51A013 |
186 HOSPITAL DRIVE |
GRANTSVILLE |
WV |
26147 |
2016-12-07 |
425 |
D |
0 |
1 |
CR3E11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed, in collaboration with the consultant pharmacist, to ensure safe and effective use of medications when it failed to notify the physician of possible drug interactions of medications administered at the same time. This was evident for one (1) of three (3) residents randomly observed during medication administration by a licensed nurse. Resident identifier: #10. Facility census: 23. Findings include: a) Resident #10 Observation during medication administration, on 12/06/16 at 8:28 a.m., found licensed practical nurse (LPN) #8 administered Levothyroxine 25 micrograms (mcg) to Resident #10. Levothyroxine is a medication used in the treatment of [REDACTED].#8 also gave Resident #10 a 600 milligram (mg) calcium tablet, and a 325 mg ferrous sulfate (iron) tablet. Observation of the ingredients listed on the stock bottle of calcium found that the tablet is comprised of 600 mg of calcium carbonate. Resident #10 was eating her breakfast at this time, and swallowed her oral medications with milk. Review of current physician's orders [REDACTED]. Review of the Medication Administration Record [REDACTED] An interview was conducted with the facility's consultant pharmacist #54, on 12/06/16 at 11:42 a.m. It was discussed Resident #10 took her Levothyroxine with milk at her breakfast meal, as well as calcium carbonate and ferrous sulfate. He said he was not aware of any problems with taking thyroid medication simultaneously with calcium carbonate and ferrous sulfate, or with a full meal. On 12/06/16 at 12:00 p.m., an interview was conducted with the director of nursing (DON). She said she was not aware of any contraindication with giving Levothyroxine, calcium carbonate, and ferrous sulfate at the same time. She said she would check with the physician. On 12/07/16 at 9:00 a.m., a review of the facility's Nursing (YEAR) Drug Handbook 35th Edition for manufacturer guidelines for the medication Levothyroxine sodium revealed the following: -Under interactions, Antacids, calcium carbonate ferrous sulfate .May impair Levothyroxine absorption. Separate doses by for (4) to five (5) hours. -Under patient teaching, Teach patient the importance of compliance. Tell him to take drug at same time each day, preferably one-half to one (1) hour before breakfast, to maintain constant hormone levels and to help prevent insomnia. On 12/07/16 at 9:10 a.m., the consultant pharmacist provided, upon request, a product guide on Synthroid (Levothyroxine sodium tablets), as is also found in the package insert of the medication. On page eight (8), line item number thirteen (13) states, Agents such as iron and calcium supplements and antacids can decrease the absorption of Levothyroxine sodium tablets. Therefore, Levothyroxine sodium tablets should not be administered within four (4) hours of these agents. Page ten (10) of this product guide warns calcium carbonate and ferrous sulfate when used concurrently with Levothyroxine sodium, .may reduce the efficacy of Levothyroxine by binding and delaying or preventing absorption, potentially resulting in [DIAGNOSES REDACTED]. Calcium carbonate may form an insoluble chelate with Levothyroxine, and ferrous sulfate likely forms a ferric-thyroxine complex. Administer Levothyroxine at least four (4) hours apart from these agents. Upon inquiry at this time, the consultant pharmacist said he typically does not address time scheduling of medications as an irregularity in which to notify the physician. The DON provided no further information prior to exit. |
2019-10-01 |