F760: residents are free of significant medication errors
Short answer
F760 requires that residents are free of any significant medication errors. CMS cites it for any significant error, whatever the facility's overall error rate. An error is significant if it causes discomfort or jeopardizes health or safety.
- Tag title
- Residents Are Free of Significant Med Errors
- Regulation
- 42 CFR 483.45(f)(2). Companion F759 covers 483.45(f)(1), the error rate
- Guidance relied on
- Appendix PP Rev. 232 (issued 07-23-25, in use since 04-28-25); F759/F760 section Rev. 173 (11-22-17)
- Rate rule (F759)
- Cited at an observed error rate of 5 percent or greater, with no rounding up. Rate is errors over opportunities (doses given plus doses ordered but not given)
- Wrong-time rule
- Counts at 60 or more minutes early or late, only if it can cause discomfort or jeopardize health. Before-meal and after-meal orders always count
- Reporting clock
- None of its own. Physician and representative notice at once (F580). Drug diversion has crime-reporting clocks (F609)
- Severity note
- No examples in the tag. Section 483.45(f) is in the substandard quality of care group
Applies to: Medicare-certified skilled nursing facilities · Medicaid-certified nursing facilities
What F760 covers
F760 enforces 42 CFR 483.45(f)(2): residents are free of any significant medication errors. Companion F759 enforces (f)(1), an error rate under 5 percent. F760 applies to any significant error, even at a lower rate.
A medication error is a preparation or administration that departs from the prescriber's order, the manufacturer's specifications (not recommendations) or accepted professional standards. It is significant if it causes the resident discomfort or jeopardizes health or safety.
How surveyors judge significance
Significance is professional judgment. Three factors guide it: the resident's condition, the drug category and how often the error happens. Narrow therapeutic index drugs carry more risk, since they leave little room between a safe and a harmful dose. Examples are warfarin, digoxin, phenytoin and lithium. A laxative missed for one day may cause little or no discomfort. Constipation lasting more than three days may be significant, CMS says.
| Type | Order | What happened | Rating |
|---|---|---|---|
| Omission | Metoprolol succinate 100 mg daily | Dose not given | S |
| Omission | Multivitamin one daily | Dose not given | NS |
| Wrong dose | Digoxin 0.125 mg daily | 0.25 mg given | S |
| Wrong route | Ear drops to left ear | Given in the left eye | S |
| Unauthorized drug | No order for warfarin | Warfarin 4 mg given | S |
| Wrong time | Oxycodone 20 minutes before a painful treatment | Given after the treatment | S |
| Wrong time | Losartan 50 mg at 8 a.m. | Given at 9:30 a.m. | NS |
What surveyors investigate and ask for
Surveyors use the Medication Administration Observation task. They watch several medication passes and compare them with the orders: right resident, time, dose, route and standard of practice. They ask the nurse about any apparent error.
| Surveyors ask for | Have ready |
|---|---|
| Current orders and the signed recap | Orders that match what was prepared, with stopped orders clearly marked |
| The medication administration record | An entry for every scheduled dose, and a reason for any dose not given. Blanks raise questions but do not prove an error |
| Explanation of an apparent omission | Interviews. A dose count if possible: doses on hand against days in use and directions |
| Records beyond the observation | Change-in-condition notes, family reports and MAR discrepancies can support an F760 citation |
| Manufacturer or standard-of-practice support | Why a drug was crushed, held or timed as it was. Sources: prescriber, pharmacist or literature |
| Follow-up on frequency | Whether an error repeated, since repetition can make it significant |
A dose count only works if the number received and the start date are charted.
What makes an F760 deficiency more severe
The F760 guidance has no severity examples, so surveyors use the CMS scope and severity matrix. Section 483.45(f) counts toward substandard quality of care, CMS's label for serious findings. It applies at immediate jeopardy (serious harm happened or is likely). It also applies at pattern or widespread actual harm, or widespread potential for more than minimal harm.
One 2024 state-posted CMS-2567 (survey findings form) cited F760 at level J (isolated immediate jeopardy) and as substandard quality of care. A resident got another resident's medications, including an antipsychotic. The immediate jeopardy began on 02/17/24 and was removed on 02/20/24. Once it is removed, surveyors lower what remains at the tag to level 2. If other residents were harmed, they lower it to harm.
Notification and reporting clocks
No federal timer attaches to a medication error. Three nearby duties apply:
- Notify the physician and family. Right away, inform the resident, consult the physician and notify the representative (42 CFR 483.10(g)(14), F580). This applies to a significant change in condition or a need to change treatment significantly.
- Diversion is a crime report. CMS treats missing or diverted resident medication as reportable misappropriation. It treats drug diversion for personal use as a likely crime. See F609: 24 hours, or 2 hours if abuse or serious bodily injury is involved.
- State rules. Some states have their own medication error reporting. Check your state's rules.
Documentation gaps that lead to citations
- An omission is noticed but not recorded or reported to the physician.
- Blanks with no reason hide whether a dose was missed or not charted.
- Fixes target one person, never the system: transcription, look-alike drugs, handoffs, interruptions, pharmacy delivery.
- No one checks frequency, so repeat omissions are never linked.
- The consultant pharmacist and medical director are left out of the review.
- Errors are counted, not trended by shift, unit or drug class. The QAA committee never sees drug regimen review data.
How to show a good investigation and fix
- Assess and notifyCheck the resident, tell the physician and representative, record the times.
- Describe the error preciselyRecord the drug, order, what was given, route, time and the resident's condition. Rate significance with CMS's three factors.
- Find the system causeWalk order to administration with the pharmacist and nurses. Look at the system, not one person.
- Correct and assignChange the process. Give each action an owner and due date.
- Verify and trendAudit the change. Bring error data to the QAA committee. See F867.
How IncidentKit supports F760
IncidentKit runs alongside your EHR and medication record. Deeper EHR integration is rolling out, so reference the entry in the incident. Lauren drafts the report for a person to review and sign. Investigations record contributing factors. Corrective actions track the fix to a verified close. Analytics show clusters by shift, location and cause.
How IncidentKit supports this requirement
| What the rule asks for | Where it lives in IncidentKit |
|---|---|
| Residents free of significant medication errors | Staff report by text, QR quick report, email or web form. A person reviews and signs Lauren's draft. |
| Judge significance and find the cause | Investigations record contributing factors and five whys. Human-authored RCA templates are rolling out. |
| Notify the physician and representative | Routing and escalation alerts the roles you set. The audit trail logs each notice. Orders and the MAR stay in your EHR. |
| Correct the process and show it held | Corrective actions carry an owner, due date, evidence and an effectiveness check. Nothing closes until verified. |
| QAA committee review of errors and drug regimen review data | Analytics cluster errors by shift, location and cause. Compliance packets include a QAPI summary. |
Product parts involved: Incident reporting, QR and quick report, Lauren, the AI assistant, Investigations and RCA, Corrective actions (CAPA), Analytics, Routing and escalation. Capabilities marked “rolling out” are being released in stages; see the changelog.
Frequently asked questions
What is the difference between F759 and F760?
F759 is the error rate: it is cited when observed errors, significant or not, reach 5 percent or greater of opportunities. F760 is cited for any significant error, whatever the overall rate.
What makes a medication error significant?
It causes the resident discomfort or jeopardizes health or safety. CMS says to weigh the resident's condition, the drug category and how often it recurs. The same omission can be minor for one resident and significant for another.
Do late doses count as medication errors?
Only if given 60 or more minutes early or late and the timing can cause discomfort or jeopardize health. Before-meal and after-meal orders always count. A long half-life drug given 15 minutes late does not.
Can an F760 citation come from records instead of observation?
Yes. CMS prefers observation. Errors can also come from record review, a change in condition tied to an error, family reports or record discrepancies. Blanks alone do not prove an error.
Sources
- eCFR, 42 CFR 483.45 ((f) medication errors), current through 2026-10-01
- CMS State Operations Manual, Appendix PP, Guidance to Surveyors for Long Term Care Facilities (Rev. 232, issued 07-23-25; revised guidance used on surveys since 04-28-25): F759 and F760 section (Rev. 173, issued 11-22-17, effective 11-28-17)
- Example CMS-2567 (North Carolina DHHS, 2024) printing the F760 title and citation 483.45(f)(2), cited at level J and as substandard quality of care
- eCFR, 42 CFR 483.10 ((g)(14) notification of changes), current through 2026-10-01
- CMS State Operations Manual, Chapter 7, Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities (Rev. 244, issued 06-26-26): scope and severity matrix, immediate jeopardy, substandard quality of care
- eCFR, 42 CFR 488.301 (definitions: immediate jeopardy, substandard quality of care), current through 2026-10-01
- CMS memo QSO-25-14-NH (revised 2025-03-10): Revised Long-Term Care Surveyor Guidance, effective April 28, 2025
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
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