Medications Left Unsecured and Medication Carts Unlocked
Penalty
Summary
Facility staff failed to ensure that medications and biologicals were securely stored in accordance with professional standards and facility policy. On multiple occasions, medication carts containing narcotics and other prescription medications were observed to be left unlocked and unattended in resident-accessible areas. Specifically, a medication cart was found unlocked and unattended by the DON, who confirmed the incident with the trained medication administrator (TMA). The TMA acknowledged leaving the cart unsecured, which contained medications such as gabapentin and muscle relaxants. Additionally, video footage reviewed by the DON showed a nurse leaving the medication cart open and unlocked while administering insulin to a resident, and also leaving insulin pens unattended at the desk. The facility's policy required all medications to be stored in locked compartments, with controlled substances requiring two locks. These observations and interviews confirmed that staff did not consistently follow procedures for securing medications, resulting in medications being left accessible to unauthorized individuals.