Health inspection·October 6, 2022

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to have a five percent (5%) or lower medication error rate. There were 26 opportunities observed with 4 medication errors resulting in a 15.38% medication error rate. This failure applied to one (R8) of nine residents reviewed during the medication administration task. Residents Affected - Few Findings include: R8 is a [AGE] year old female admitted into the facility on [DATE] with diagnoses including: chronic obstructive pulmonary disease, acute respiratory failure with hypoxia, hypertensive heart disease, dysphagia, bipolar disorder, major depressive disorder, and anxiety disorder. On 10/03/2022 at 10:54am medication administration was observed with V4 (LPN) on 5 South. During observation, V4 (LPN) crushed extended release medication and medications that are required to be given whole. There was one medication not available for R8. Resident # 8 at 11:50am Creon delayed release 12000-38000 unit capsule give two capsules by mouth with meals. V4 (LPN) crushed this medication. Resident #8 at 1:35pm Gabapentin 300mg give 1 capsule three times a day related to pain to right knee. (This medication was crushed). Benzonatate 100mg give one capsule by mouth three times a day (Medication was crushed). Cyclobenzaprine HCL 5mg give one Tablet by mouth three times a day for muscle pain. Lorazepam 0.5mg one tablet by mouth two times a day for anxiety not given (medication was not available). Interview with V4 said, the medication is not here. I think it is a problem with the pharmacy. She been out for two days. On 10/03/2022 at 2:07pm, Interview with V4 (LPN) said, We should not crush extended release or the ones with the coating. I don't know, I think it's because the chemical reaction because it supposed to work over a long period of time and the extended release won't work anymore. We should have called the doctor for another way to give like liquid or something. We have a medication (emergency box) it has medications, or we will go to another unit to see if they have any. No, the box does not have controlled medications on the cart. R8's Lorazepam is not here, she had some, but I think she ran Page 1 of 2 146176 146176 10/06/2022 Celebrate Senior Living Niles 7000 North Newark Niles, IL 60714

F 0759 out and the insurance won't cover it. Level of Harm - Minimal harm or potential for actual harm On 10/04/2022 at 2:40pm Interview with V2 (DON) said, I am the (DON) Director of Nursing I have been here since 09/14/2022. First, they should not crush capsules, capsules are not made to be crushed. We have an hour before and an hour after to pass medications so they can start giving medications at 7am and should be completed by 9:00am. Extended release medications should not be crushed. If a patient cannot swallow a medication, we can call the doctor and ask for another form of the medication. We normally call pharmacy before the medications run out depending on how often the resident is taking the medication; for narcotics, I tell the nurses to call when the bingo card has 10 left. Normally if it is an issue with insurance, the pharmacy will send a paper and ask if we would like to pay for it. The facility has not denied any since I've been here. I've only seen this happen one time and the facility did cover the medication. The emergency box does not have Narcotics in them. If the medication is not available, the nurse is supposed call the pharmacy. Nurses should call the doctor and let them know the resident has an issue with their insurance and the doctor can give a different brand because sometimes the insurance won't cover name brand medications, or they will not pay for the number of pills so we might need to request a lower number to get it approved. The nurse should call the doctor and let them know the medication was not given. Residents Affected - Few Record review of a document submitted by facility titled Medication Administration with effective date of 10/25/2014 under policy states: Medications are administered as prescribed in accordance with good nursing principles and practices and only by persons legally authorized to do so. Personnel authorized to administer medications do so only after they have been properly oriented to the medication management system in the facility. The facility has sufficient staff and a medication distribution system to ensure administration of medications without unnecessary interruptions. On the second page number 7 under procedure states: Tablet crushing/ capsule Opening: Crushing tablets may require a physician's order, per facility policy. If it is safe to do so, medication tablets may be crushed or capsules emptied out when resident has difficulty swallowing or is tube-fed, using the following guidelines. Letter a: states: Long-acting or enteric-coated dosage forms should not be crushed; an alternative should be sought. Some long-acting capsules can be opened and administered (Without crushing contents) Gloving is recommended to protect the nurse form exposure to contents of the capsule. Check with pharmacist before opening any capsules. On page 3 letter e states: For residents able to swallow or have difficulty swallowing tablets which can be appropriately crushed may be ground coarsely and mixed with the appropriate vehicle (such as Applesauce) so that the resident receives the entire dose ordered. Please consult with the product literature or DO NOT CRUSH lists which the facility may have or with the pharmacist if there is a question about medications to be crushed. 146176 Page 2 of 2