A facility failed to act on CP medication regimen review recommendations for three residents. Issues included unaddressed PRN psychotropic and pain-med orders, lack of stop dates and rationale for PRN insomnia meds, failure to clarify pain scales for PRN analgesics, and an acetaminophen liquid dose that was difficult to measure. Nursing staff acknowledged some of the orders were confusing, and one resident received PRN tramadol even when the documented pain score was 0.
A resident with type 2 DM, gait and mobility abnormalities, and severe cognitive impairment did not receive a documented monthly medication regimen review from the pharmacy consultant for one month. The PC binder showed only the initial admission EPIC review, and the DON stated the resident was in the hospital when the PC visited that unit, leaving no documented February MRR.
A resident with severe cognitive impairment and G-tube feeding had CP recommendations left unsigned and not documented as followed up. The CP had recommended clarifying a Flomax order because the capsule should be swallowed whole and adjusting Lidoderm patch timing to 9 AM to 9 PM, but the MAR showed different patch times and the record initially showed no follow-up by the DON or nursing staff.
Surveyors found that the facility did not follow pharmacy consultant recommendations for two residents, resulting in medication orders not being updated as advised. Recommendations regarding clarification and administration of medications, including pain management and specific dosing instructions, were not implemented or properly documented, despite facility policy requiring timely review and action by nursing and medical staff.
A resident with anxiety and depression was prescribed Valium as needed and fluoxetine daily, but staff failed to document behavior monitoring or the use of non-drug interventions prior to administering Valium, despite pharmacy recommendations and facility policy. Staff interviews and record reviews confirmed the lack of required documentation and monitoring.
A facility failed to ensure a Consultant Pharmacist identified a drug interaction between Levothyroxine and Calcium Carbonate for a resident. The medications were not consistently spaced four hours apart as required by manufacturer's specifications, which could affect the efficacy of Levothyroxine. The resident's thyroid panel showed fluctuations, but the Consultant Pharmacist did not recommend adjusting the medication timing.
A facility failed to ensure the Consultant Pharmacist identified and reported irregularities in medication management for a resident. The CP did not notice that a nurse was not documenting the resident's blood pressure when administering Cozaar, which was prescribed with a parameter to hold if the systolic BP was below 110. This oversight occurred multiple times over several months, despite the facility's policy requiring the CP to communicate potential or actual problems related to medication therapy.
A facility failed to promptly act on a consultant pharmacist's recommendation to discontinue a PRN medication for a resident with severe cognitive impairment. Despite indicating the medication was discontinued, records showed a delay of 45 days before action was taken. The DON admitted to not regularly reviewing recommendations for accuracy, contrary to facility policy.
A facility failed to ensure physician response to pharmacy recommendations for a resident with dementia and Alzheimer's. The pharmacist recommended increasing Aricept and Namenda dosages to achieve maximum effectiveness, but the physician did not document any response or rationale for not acting on these recommendations. This lack of action was confirmed through interviews and record reviews.
A facility failed to ensure a CP identified and reported a medication administration irregularity for a resident with severe cognitive impairment. The resident, on an NPO diet and receiving medications via a g-tube, had a physician's order for Donepezil to be administered orally. The CP did not report this discrepancy, contrary to facility policy.
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