Drug management at Limerick nursing home ‘posed risk’ to residents: HIQA

Mike Dwane

Reporter:

Mike Dwane

The concerns arose from an unannounced inspection of Athlunkard Nursing Home in Westbury
HIQA has expressed “serious concerns” over the administration of medication at a city nursing home, finding that “management practices were not robust and posed a risk to residents”.

HIQA has expressed “serious concerns” over the administration of medication at a city nursing home, finding that “management practices were not robust and posed a risk to residents”.

The concerns arose from an unannounced inspection of Athlunkard Nursing Home in Westbury on January 20 last, when 97 residents were being cared for on site.

Inspectors found evidence on that date that staff were unclear in some cases on what medicines to administer. They also found instances where elderly residents were not being given medication prescribed by their GP and other cases where incorrect doses were administered.

Management of medication was one of a number of areas examined by HIQA where Athlunkard Nursing Home was deemed to be in “major non-compliance” with the outcomes the authority inspects against.

“These issues of concern were brought to the attention of the provider/person in charge on the day of inspection, [and] an immediate action plan was issued following the inspection,” the report states.

“While there were systems in place to review some aspects of the safety and quality of care, the inspectors were concerned that there were inadequate governance arrangements in place to maintain oversight of all departments including medication management, clinical assessment and care, risk management, staff training, house keeping/cleaning and infection control. The provider advised inspectors the day following the inspection of the immediate actions she had taken to address the medication management issues and further actions she proposed to take to address other issues identified on inspection.”

Specific failings on the management of medication are detailed in the report.

“There was evidence that medications prescribed to commence for one resident on January 16, 2015 were recorded for November 2014. Medications discontinued by the GPs were not dated or signed. Medications that staff stated were administered as crushed to a resident were not prescribed for administration in a crushed format. One resident had two medication prescription charts for medications prescribed PRN [on an as required basis]. Three medications discontinued on one chart were prescribed to be administered on the second chart. Staff were unclear as to which chart was to be used,” the report states.

It goes on to state that: “Incorrect doses of medications as prescribed by the GPs on the residents’ prescription chart were administered to residents. For example, one medication was prescribed to be administered four times a day (QDS). There was evidence that this medication was given once a day for six days in December 2014 and was not administered on one day in January 2015. Another medication (analgesia) was prescribed to be administered three times a day. There was evidence that this medication was not administered as prescribed.”

In its response to the HIQA findings, the operator of the nursing home - Killure Bridge Nursing Home Partnership - stated that medication management training had been delivered to staff and that all nurses were due to have received training by the end of last month.

“All medication charts identified have been reviewed. All prescribed medications are being given to residents. In conjunction with the nursing staff and the pharmacist, the newly-appointed person-in-charge is undertaking a comprehensive review of all aspects of medication management. An action plan (to involve all relevant stakeholders) is being put in place to ensure that the centre will comply with local policy and the statutory requirements of medication management. This will ensure that drug prescription charts are kept up to date, ensuring evidence of rationale for residents not receiving medication is clear and ensuring medications no longer prescribed are discontinued in line with current prescription,” the nursing home stated.