Improper Storage of Medications in Multiple Medication Carts
Penalty
Summary
Surveyors observed that medications were not properly stored in three medication carts located in different halls of the facility. Specifically, the 500 Hall medication cart contained five loose pills in the second drawer and four loose pills in the third drawer, all of various sizes, shapes, and colors, mixed among sealed and labeled resident medication blister packets. The 400 Hall medication cart had two loose pills in the second drawer, and the 200-300 Hall medication cart had fourteen and a half loose pills in the third drawer, also among sealed and labeled blister packets. These observations were made during medication storage checks with LPNs present. Interviews with staff revealed that there was no consistent process for cleaning out the medication carts, with the nurse supervisor indicating that night nurses might clean the drawers but not necessarily every night, and that all nurses are responsible for keeping the carts clean. The DON confirmed that medication carts should be cleaned routinely and that all nurses are responsible for checking them, but acknowledged that finding several loose pills in each drawer was not acceptable. The facility's policy requires medications to be stored in their original packaging and for storage areas to be kept clean, safe, and sanitary, which was not followed in these instances.