Improper Labeling of Aplisol Vial
Penalty
Summary
The facility failed to properly label a multi-use vial of Aplisol in the medication room, as observed during a survey. The manufacturer's directions for Aplisol, a tuberculin purified protein derivative, specify that vials in use for more than 30 days should be discarded due to potential oxidation and degradation affecting potency. However, during an inspection of the medication room refrigerator, a multi-use vial of Aplisol was found open and undated, indicating non-compliance with labeling requirements. An interview with an LPN at the time of the observation confirmed that the vial was not dated and should be discarded. Further confirmation from the Director of Nursing reiterated that the vial should have been dated upon opening and discarded once expired. This deficiency was noted under the regulations for pharmacy and nursing services, highlighting a lapse in the facility's adherence to proper medication labeling and storage protocols.
Plan Of Correction
The undated multi-use vial of Apisol was immediately disposed of, and another multi-use vial was replaced. Residents who have orders for Tuberculosis (TB) skin test have the potential to be affected. Baseline audit was completed to ensure that Apisol vials were dated for 28 days after opening. Licensed staff were educated by Staff Development Nurse on the process for dating prescribed items when opened and their recommended expiration date. Monitoring will be captured through auditing prescribed items for dating items when opened with their recommended expiration date. Audits will be conducted 2 times weekly for 4 weeks on 4 medications, then once monthly for 2 months on 4 medications. The audits will be conducted by the Staff Development Nurse or designee. Results of the audits will be provided to the Administrator and be presented for review at the monthly Quality Assurance Improvement Committee (QAPI) meeting monthly for a period of three months. Any revisions to the audit plan will be reviewed and implemented with the coordination of the Interdisciplinary team at QAPI Committee meeting.