{"report_id":200,"form_id":"23","user_id":81,"organization_id":10,"question_id":"100","question_type":"Free_Text","text_answer":"Staff not providing the correct medication dosage to an individual was influenced by the staff being unware of the increase in the medication dosage. A contributing factor to the unawareness of the increase was that information was not communicated to the staff in the transition time because there is not enough time available to read the health progress notes.  The short amount of staff transition time is impacted by the provider not building transition time into the staff schedules due to contributing factors of the weather, the staff\u2019s second job, and the labor laws.  The other influencer is the CSSP and the 6790 does not allow the ability of the rate system to pay the provider more to have staff overlap on the shift change.  Another contributor of the staff not being able to communicate during the transition is there are several documentation points for communication for each individual living in the home thus requirements set for by licensing 245D.  \r\n\r\nStaff giving the incorrect dosage was also influenced by the documentation was not completed in the Medical Administration Record (MAR). At this home, it was the supervisor\u2019s role to update medication changes in the MAR.  The individual\u2019s medication administration had complexities to giving the medications that were not relayed in the MAR as the individual was to receive two different types of insulin and staff relied on the previous MAR to provide the medication.  The influence of the MAR not being updated is the provider experiencing frequent lapses in internet connectivity (which occurred frequently at the residence) and the MAR is an electronic document, thus the documentation is in two places and not reviewed by all staff.  The supervisor had relied on the protocol for the med changes that is given by the physician, which has an outside influence of the pharmaceutical laws that informs the physician on how to write the protocols.  \r\n\r\nA final influence to staff giving the incorrect dosage was that they were using an \u201cold\u201d prescription because the physician did not change the prescription with the pharmacy.","created_by":81,"updated_by":81,"updated_at":"5\/26\/2021 4:26:48 pm","created_at":"5\/26\/2021 4:26:48 pm","id":37017}