Medication Storage and Access Deficiencies
Penalty
Summary
The facility failed to store Schedule II-V medications in a separately locked, permanently affixed compartment in three of four medication rooms reviewed. Specifically, in the medication rooms for wings A/B, C/D, and E/F, Lorazepam, a controlled antianxiety medication, was found in clear plastic locked boxes that were not permanently affixed to the refrigerator shelves, allowing for potential removal. Licensed Practical Nurses (LPNs) confirmed during interviews that the storage did not comply with the facility's policy requiring these medications to be stored in a permanently affixed, double-locked compartment. Additionally, the facility did not prevent unauthorized access to medications on two of four medication carts observed. On the D and F wing medication carts, open bottles of medications such as MiraLAX, Pepto-Bismol, and Robitussin were left on open shelves at the back of the carts, which were positioned facing the hallway and out of the nurse's view while attending to residents. LPNs confirmed that these medications should not have been accessible and should have been locked in the medication cart. Furthermore, the facility failed to appropriately discard outdated medications. An open pen of Lantus insulin on the E wing medication cart lacked an 'opened on' date, which is required to ensure the medication is used within the manufacturer's recommended timeframe. The LPN confirmed that without an opened date, the insulin should have been discarded, as per the facility's policy and manufacturer's guidelines.
Plan Of Correction
1. The refrigerators were fixed at the time of the survey. A medication box was installed and permanently affixed in the E/F wing medication refrigerator. The A/B and C/D wing medication boxes were permanently affixed to the refrigerator at the time of the survey so they were not able to be removed with the shelf. The open Lantus insulin pen was discarded at the time of the survey. The Miralax, milk of magnesium, and Robitussin were removed from the back of the medication cart. 2. An audit will be completed of all refrigerators to ensure that the refrigerators are in compliance with the medication boxes permanently affixed to the refrigerator and all Scheduled II-V medications. An audit will be completed of all insulin vials and pens to ensure if they are opened there is a date on the pen or vial. All medications were removed from the back of the medication carts. 3. All nursing employees will be reeducated on the following policies and procedures titled: Narcotic Policy PCM, Medication Cart: Med Pass Guidelines, and Pharmaceutical Services and Medication Storage. 4. An audit will be completed by the Quality Nurse or designee to ensure that the medication boxes are permanently affixed and Schedule II-V medications are stored in the box within the medication refrigerator. These audits will be completed monthly and then quarterly thereafter. An audit will be completed on insulin vials and pens to ensure if they are dated if opened and if expired discarded. An audit will be completed monthly and then quarterly thereafter. Audits on all medication carts to ensure that there are no medications on the back of the medication carts will be completed weekly for one month, monthly for two months, and quarterly thereafter. These results will be reported quarterly to the Quality Assurance Performance Improvement Committee. 5. Corrective action date is April 10, 2024.