Delayed Disposal of Controlled Medications
Penalty
Summary
The facility failed to ensure the timely disposal of controlled medications for a resident, identified as Resident R162, who was admitted on September 23, 2024, and discharged against medical advice on October 24, 2024. During her stay, she had prescriptions for Morphine Sulfate, a Schedule 2 controlled medication, and Lorazepam, a Schedule 4 controlled substance. These medications are known for their potential for misuse and dependence. Upon review, it was found that the controlled medications were not disposed of until January 9, 2025, which was 11 weeks after the resident's discharge. The delay in the disposal of these medications was confirmed through an interview with the Director of Nursing, Employee E2, who acknowledged that the disposal was not conducted in a timely manner. The nursing note from January 9, 2025, indicated that all medications, including the controlled substances, were counted and destroyed on that date. However, the facility's failure to dispose of these medications promptly after the resident's discharge constitutes a deficiency in their pharmacy services, as it did not comply with the requirement for timely reconciliation and disposal of controlled drugs.
Plan Of Correction
All medication for R162 have been destroyed. The Staff educator or designee will in-service all Licensed nurses on the importance of timely disposal of medications after discharge. All Medication Carts and Medication rooms were inspected by unit managers and there are no further incidents of untimely disposal of medication. Unit managers or designees will conduct audits on discharge residents weekly for 4 weeks to ensure timely disposal of medications. Results will be reported in monthly QAPI.