Failure to Discard Expired Insulin and Timely Reorder Medications
Penalty
Summary
The facility failed to provide adequate pharmaceutical services for several residents, specifically in the management and administration of insulin and antianxiety medications. For five residents reviewed, surveyors found that insulin pens (Humalog, Lispro, Novolog) were not discarded after the required 28 days from opening, as per facility policy and manufacturer guidelines. These insulin pens remained in the nursing carts past their expiration, and nursing staff were unable to provide a reason for not discarding them. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) acknowledged that it was the nurses' responsibility to remove expired insulin but could not explain why this was not done. Additionally, one resident did not receive their prescribed Lorazepam 0.5 mg for anxiety for ten consecutive days because the medication was not available. The medication was not reordered in a timely manner, and there was a lack of communication between medication aides, nurses, and the ADON regarding the need for a refill. The facility's policy required medication aides to reorder medications before they ran out and to notify the charge nurse if medications were unavailable. However, this process was not followed, resulting in missed doses. The residents involved had significant medical histories, including diabetes, schizoaffective disorder, neurocognitive disorder, paraplegia, and anxiety disorder. At the time of the deficiencies, some residents had severe cognitive impairment, while others were cognitively intact. The failures in medication management were identified through observation, record review, and staff interviews, with staff confirming that the required procedures for medication disposal and reordering were not followed.