Violation Details: 00362882-AP-313111

Records Request Print
Date
10/24/2024
Report number
00362882-AP-313111
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Rule(s) Violated
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
Findings
Alleged Victim (AV) relies on the facility for his/her care needs. Alleged Perpetrator 2 (AP2) had training with AV’s medication. On or about October 24, 2024, AV was to receive two units of (medication 1) for sliding scale and eight units of (medication 2). When giving AV (hormone), AP2 made a mistake and gave AV a dosage of the wrong (hormone). AP2 was supposed to give AV 30 units of long lasting but instead AP2 gave AV 30 units of fast action, along with 2 units of AV’ sliding scare (hormone). As a result of the medication, AV was transported to the hospital for care. AP2 failed to provide a safe medication system for AV, which is neglect of care and constitutes abuse. The facility failed to assure AV received a safe medication administration system, which is a violation of Oregon Administrative Rules.