Medication Labeling and Storage Deficiencies Identified
Penalty
Summary
Surveyors observed multiple failures in the facility's medication management practices. For one resident, a bottle of artificial saliva (eye medication) was found on the medication cart without an open date, and the Assistant Director of Nursing confirmed that the medication should have been dated when opened. Similarly, another resident's insulin pen was observed with a blank 'Date Opened' field, and the nurse stated that the open date should have been recorded. Both the Assistant Director of Nursing and the Director of Nursing acknowledged that medications should be dated upon opening, and the facility's policy requires opened multidose vials to be dated and discarded within 28 days. A separate incident involved a resident's lorazepam, which was found without a legible medication label. The registered nurse present confirmed the label was not legible and stated that a new medication should be ordered in such cases. The Director of Nursing further clarified that medication labels must include specific information such as prescription number, physician's name, date filled, expiration date, medication name, and resident identification, and that labels must be legible. The facility's policy also requires that medications with missing or illegible labels be returned or destroyed per pharmacy instructions. Additionally, an unattended medication cart was observed in a hallway with a set of keys and a cup containing five unidentified, loose pills on top. The responsible nurse admitted that both the keys and medications should not have been left unattended and should have been secured. The Director of Nursing confirmed that leaving medications and keys unattended is unacceptable and poses a security risk. Facility policy states that medication carts must be locked when not in use and never left unattended if open or accessible.