Other·July 7, 2021

F760 The facility must ensure that its- §483.45(f)(2) Residents are free of any significant medication errors. On 5/19/2021, an unannounced visit was conducted at the facility to investigate a facility reported incident about allegation of resident abuse. The facility failed to administer Symbicort (medication to treat chronic obstructive pulmonary disease [COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs]) as per facility’s policies and as ordered by the physician for Resident 1 upon readmission from 3/13/2021 to 5/13/2021. Resident 1 was given Symbicort twice every 10 days rather than twice daily as ordered by the physician. As result, Resident 1 missed a total of 110 doses of Symbicort from 3/13/2021 to 5/13/2021, placing the resident at high risk of severe health complications possibly leading to hospitalization and/or death. A review of Resident 1's Admission Record (Face Sheet) indicated the facility admitted the resident on 1/14/2021 and readmitted on 3/13/2021 with a diagnoses including diabetes (uncontrolled elevated sugar in the blood), chronic respiratory failure (condition in which not enough oxygen passes the lungs into the blood) with hypoxia (low oxygen level in the blood stream). A review of Resident 1's Minimum Data Set (MDS - a comprehensive assessment and screening tool) dated 2/9/2021 indicated the resident needed extensive assistance from staff for all activities of daily living (ADL-personal hygiene, bed mobility, dressing, and transfers). A review of Resident 1's Physician’s Orders dated 3/13/2021, indicated an order for Symbicort 80-4.5micrograms (mcg-unit of measure) inhaler, administer two puffs twice a day for shortness of breath (SOB) and wheezing (sound produced when airways are tightened or blocked). A record review of Resident 1's MARs dated 3/2021 to 5/2021 indicated an order for Symbicort 80-4.5 mcg inhaler, administer two puffs twice a day every 10 days for SOB and wheezing. A review of Resident 1's MAR dated 3/2021, indicated Symbicort 80-4.5mcg inhaler was only given a total of four doses, twice on 3/14/2021 at 9 a.m. and 5 p.m. and twice on 3/24/2021 at 9 a.m. and 5 p.m. A review of Resident 1's MAR dated 4/2021, indicated Symbicort 80-4.5mcg inhaler was only given a total of four doses, twice on 4/13/2021 9 a.m. and 5 p.m. and twice on 4/23/2021 9 a.m. and 5 p.m. A review of Resident 1's MAR dated 5/2021, indicated Symbicort 80-4.5mcg inhaler was only given a total of four doses, twice on 5/3/2021 9 a.m. and 5 p.m. and twice on 5/13/2021 9 a.m. and 5 p.m. During an interview and concurrent record review on 5/19/2021 at 12:54 p.m., with Licensed Vocational Nurse 1 (LVN 1), Resident 1's Physician Orders were reviewed. LVN 1 confirmed a Physician’s Order dated 3/13/2021 for Symbicort 80-4.5mcg inhaler, ordered for two puffs twice a day. During an interview and concurrent record review on 5/19/2021 at 12:54 p.m., with Licensed Vocational Nurse 1 (LVN 1), Resident 1's MARs from 3/2021 to 5/2021 was reviewed. LVN 1 confirmed the transcribed order for Symbicort 80-4.5mcg in Resident 1's MAR as to be given every 10 days. LVN 1 confirmed that the transcribed order for Symbicort did not match the physician's order. LVN 1 stated that Symbicort should have be given to Resident 1 twice a day rather than twice every 10 days. During an interview on 5/19/2021 at 1:11pm, with Assistant Director of Nursing (ADON), ADON stated Symbicort inhaler should be given twice a day. ADON stated Licensed Vocational Nurse 2 (LVN 2) received a physician order of Symbicort inhaler 80-4.5 mcg two puffs twice a day but transcribed it as two puffs twice every 10 days. During an interview on 5/20/2021 at 2:22 p.m., with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated that they readmitted Resident 1 to the facility on 3/13/2021. LVN 2 stated she received an order from Attending Physician 1 (AP 1) for Symbicort 80-4.5mcg inhaler, two puffs, twice a day for Resident 1. LVN 2 stated that when she transcribed the Symbicort 80-40.5 mcg frequency, she erroneously entered the medication to be given every 10 days to Resident 1, rather than daily. LVN 2 stated she did not review the orders for accuracy causing the wrong frequency of Symbicort to be transcribed. LVN 2 admitted that she erroneously entered the order as twice a day every 10 days resulting in a total of 110 missed dosages. LVN 2 stated when she did the recapitulation of orders for the month of March 2021 and April 2021, she did not thoroughly look at the Physician Orders upon readmission on 3/13/2021 to ensure accuracy of transcription of orders for Resident 1. During an interview on 5/20/2021 at 3:18 p.m., with Director of Nursing (DON), DON stated LVN 2 should have transcribed the order for Symbicort as daily instead of every 10 days as what the physician order indicated. DON stated that giving the Symbicort as ordered is important for Resident 1 to prevent any episode of shortness of breath and wheezing, which can lead to complications and hospitalization. A review of facility policy and procedure titled, "Administering Medications", dated 4/2019, the P&P indicated, "Medications are administered in accordance with prescriber orders, including any required time frame. Medications errors are documented, reported, and reviewed by the Quality Assurance and Performance Improvement (QAPI) committee to inform process changes and or the need for additional staff training. The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time, and right method of administration before giving the medication. A review of facility's policy and procedure titled, "Monthly Review of Physician Orders", dated 7/23/2003, indicated, "Recap all orders that have been added to the physician's orders since the last recap (if telephone orders are recapped daily), or since the last months printing ...Review all orders written since the previous month review. Review of New Recapped Physicians Orders on receipts of new orders. 1. Check recaps for correct dosage, time frames, to determine if all orders have been brought forward that are to be continued. 2. Check the physician orders against the previous months medication/treatment sheets." The facility failed to administer Symbicort (medication to treat chronic obstructive pulmonary disease [COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs]) as per facility’s policies and as ordered by the physician for Resident 1 upon readmission from 3/13/2021 to 5/13/2021. Resident 1 was given Symbicort twice every 10 days rather than twice daily as ordered by the physician. As result, Resident 1 missed a total of 110 doses of Symbicort from 3/13/2021 to 5/13/2021, placing the resident at high risk of severe health complications possibly leading to hospitalization and/or death. The above violations jointly or separately had a direct or immediate relationship to the health, safety, or security of Resident 1.