IDPH has cited and fined Lexington of Orland Park nursing home after the failure to give anti-seizure medications resulted in a resident requiring a lengthy admission to the intensive care unit of the hospital.
One of the basic functions that a nursing home carries out is the administration of medications as ordered by a physician. With some medications, it is absolutely critical that the medication be given as ordered. Anti-seziure medications fall under that category, as the failure to get needed anti-seziure medications can result in the resident experiencing seizures which may cause brain damage.
The resident at issue suffered from seziures after contracting encephalitis as a child in 2001. He was on a regimen of six anti-seizure medications which he and his mother managed at home. He was admitted to the nursing home on March 19 for strengthening after a hospital admission. The transfer orders included giving all six anti-seizure medications. The hospital delayed transferring him to the nursing home until he had received his last medication for the day.
To say the least, the nursing home did poorly in giving him the medications that had been ordered for him:
- Medication #1 was to be administered twice per day at 9:00 a.m. and 9:00 p.m. The 9:00 a.m. dose was given at 1:50 p.m. on March 20, nearly 5 hours late, and the evening dose was not given.
- Medication #2 was to be given twice per day, the first dose was supposed to be 1 tablet, the second dose 1.5 tablets. The resident never received these medications on March 20 or March 21 because the medication was not avsilable.
- Medication #3 was to be given 1 tablet in the morning and 1.5 in the evening. The resident did not receive any of this medication on March 20 and on March 21 and 22, the medications were given in backwards order (1.5 tablets in the morning and 1 in the evening).
- Medication #4 was supposed to be administered each night. It was not given on March 20.
- Medication #5 was supposed to be given every 12 hours. It was not given on March 20.
- Medication #6 was supposed be given with a dose of 2.2 ml twice daily for 1 week then increased to 4.4 ml twice daily. On March 20, he received only a single dose at 2.2 ml. On March 21, he received a dose of 2.2 ml at 5 pm and a 4.4 ml dose at 10 pm. On March 22, he was given three doses: 2.2 ml at 9 am and 5 pm with a 4.4 ml dose at 11 am. On March 23, he again received three doses: 2.2 ml at 9 am and 5 pm with a 4.4 ml dose at 11 am.
For those keeping score at home, there were six anti-seizure medications that were ordered to be given in a set way. None of the six anti-seizure medications were in fact given to the resident as ordered. In short, a series of serious nursing home medication errors.
What happened as a result?
On March 22, the resident had seizure activity for 5-10 minutes which was observed by a CNA and reported to the nurse, but the nurse apparently failed to notify the resident’s doctor. The following morning, the resident’s chart reflected that he had altered mental status due to seizure activity the day before. That afternoon, the resident’s mother was visiting him and he had another seizure. This time, paramedics were called and he was brought to the hospital where he was stablized, then transferred to another hospital where he was admitted directly to the intensive care unit where he was unresponsive for 11 days. His mother reported to the surveyor that after the seizures he was now incontinent.
When interviewed by the state surveyor, the resident’s neurologist stated that following the regimen of anti-seizure medication was critical and that administering medication late by as little as 90 minutes is “pushing it” and that the levels of anti-seizure medicstions drop very quickly. In his opinion, the failure to give the medications as ordered played a role in the resident’s seizures.
There are obvious medication errors that occurred, but beyond that, there is a larger story to be told. The nursing home did not have all of the medications needed on hand when the resident was admitted to the facility. When a resident is admitted to a nursing home, one of the things that the nursing home receives in advance of the resident showing up on their doorstep is the list of the medications that the resident is supposed to receive. If the resident requires medications that are not on hand at the nursing home, then there needs to be a system in place to ensure that they are on hand when the resident needs them. That system either does not exist or failed badly in this case.
Past the nursing home medication error, the nursing home staff failed this resident once the seizure activity began. The occurrence of seizure activity represented a significant change in condition requiring physician notification. There is nothing in the citation which indicated that this occurred. The following morning, the resident had a change in mental status which was attributed to the seizure. Again, no physician notification is reflected in the citation. It wasn’t until he had an additional seizure in the presence of his mother that he was sent to the hospital. Earlier action to have the resident sent to the hospital very well could have prevented the second seizure.
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