SPRINGFIELD, IL – The Illinois Department of Public Health has fined Magnolia Manor Skilled Nursing Facility $10,000 (Statement of Violation) for failing to ensure residents receive the proper medications. The 97-bed skilled care facility is located at 2102 Metropolis St. in Metropolis.

Responding to an incident report, Department surveyors discovered staff had given medication to a new resident that had not been ordered. Less than an hour later, the resident developed breathing problems, his blood pressure dropped and he died.

Staff notified the hospice nurse, the facility's director of nursing and the resident's family of the medication error and change in condition, but not the resident's physician, as required by facility policy.

The resident, who had recently been admitted, was unfamiliar to the nurse who provided the medication and was in the same room with another new resident. Prior to administering the medicine, the nurse entered the room and called out the resident's name. The other resident in the room pointed to the man in the "B" bed and the medication was given as prescribed.

One hour later, the same nurse entered the room to administer another medication and mistakenly determined it, too, was for the resident located in the "B" bed. The resident's physician said the combination of medications "absolutely could have hastened his demise."

A Department-ordered plan of correction required facility administration to ensure guidelines are in place for properly dispensing, administering and disposing of drugs and medications in order to meet the personal safety and health needs of its residents.