An Iowa nursing home was cited by the state after a certified nurse aide (CNA) accidentally placed fingernail glue into a resident’s eye. According to the state inspection report, a male resident of the nursing home arrived in the dining room with a small bottle he had found on his bedside table and asked a CNA to assist him with putting in eye drops. The CNA proceeded to administer the drops into the resident’s right eye without confirming the bottle was eye drops. After the CNA placed a drop into the resident’s right eye, he immediately complained of pain and burning. The CNA then identified the bottle as fingernail glue.
The facility called 911 and notified the doctor on call. A team of emergency medical technicians (EMTs) arrived and assisted with flushing the resident’s right eye. During the flushing of the eye the resident received tramadol and Tylenol for pain. Once the eye was opened, his eye appeared red, and the resident complained of blurry vision.
The resident was treated for pain and vision-related issues over the next two weeks. State inspectors noted that according to the facility’s own policies, only a licensed nurse should have administered medications and that the man had not been prescribed any eye drops. The resident told inspectors he had no idea why there was fingernail glue on his bedside table, but said that he felt sure one of the staff must have left it there.
Compliance Perspective
Issue
Facilities must ensure that the resident environment remains as free of accident hazards as is possible; and each resident should receive adequate supervision and assistance devices to prevent accidents. Facilities must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. Facilities must also ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.
Discussion Points
- Review policies and procedures on medication management, safety, and resident care plans. Also review policies and procedures related to staff responsibilities and scope of practice.
- Educate staff on your medication policies and the importance of not performing unauthorized tasks.
- Periodically perform audits to ensure resident care plans are being followed, medications are being administered correctly, and that staff are not operating outside of their scope of practice.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
