IDPH has cited and fined Generations at Rock Island nursing home after a resident had to be hospitalized due to seizure activity after not receiving his anti-seizure medications for 36 hours after admission.
The resident at issue had been admitted to the facility from home. He had a history of a brain injury and seizures and was to receive two anti-seizure medications (levetiracetam and oxcarbazepine) twice per day, at 8 am and 8 pm. Before being admitted to the nursing home, his seizures were being managed by a neurology clinic which had prescribed these medications.
Before a resident is admitted to the nursing home, there is a process by which the resident is screened to determine whether the nursing home can meet the care needs of the resident. If the nursing home cannot meet the care needs of the resident, then the proper course of action is to decline the admission. Part of the screening process is obtaining information about the resident’s medical history, their active diagnoses, and the medication and other treatment orders.
Once the resident is admitted to the nursing home, the resident must have an attending physician for manages the overall medical care of the resident, including signing orders for medications and other treatment orders as needed. Obtaining the signed orders for medications is important in assuring proper care for the resident because there are some medications which the nursing home will not keep on hand and the pharmacy will not dispense to the nursing home without a signed order. Anti-seizure medications fall into that category.
When the resident arrived at the nursing home during the middle of the afternoon, the admitting nurse asked a nurse practitioner who was in the facility to sign off on the orders for the anti-seizure medications, but she declined to do so. The admitting nurse then contacted the medical director, but could not speak with him and left a message. He did not return the call until 1:55 p.m. the following afternoon, and the medication orders were not entered into the resident’s electronic medical record until after 4 p.m. As a result, the medications did not arrive in the facility during the resident’s second day in the nursing home. Because of this, the resident missed three doses of each of the two anti-seizure medications he was due to receive – the 8 pm dose the first day he was in the facility, and both doses the second day.
At about 8:30 p.m. on the second day, the resident was able to speak normally with an aide. About 10 minutes later, that same aide walked by the resident’s room, looked in and saw that the resident was having a seizure. The resident had wet himself, the right side of his body was limp, but he was shaking violently, nonresponsive, and had his eyes rolled back into his head.
911 was called and the resident was brought to the hospital to receive care for the seizures. His treating doctor attributed the seizures to the missed doses of medication.
Making sure that medications are given as ordered is crucial to ensuring the well-being of nursing home residents. When the nurse practitioner refused to assume care of the resident, the admitting nurse did the right thing by reaching out to the medical director to get orders for the medication. However, when she could not reach him, simply waiting for a return call was not acceptable practice given the importance of the medication in the overall care of the resident. Follow-up phone calls to the medical director or contacting the regular prescribing doctor was what was required. This nursing home medication error to a critical lapse in the care of this resident.
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