Unattended and Unlocked Medication Cart Found in Facility
Penalty
Summary
Med Cart A was observed to be unlocked and unattended on two separate occasions near the main nursing station, with the lock mechanism visibly disengaged. During these times, residents, family members, staff, and surveyors were able to walk by the cart, which contained insulin, over-the-counter, and prescription medications. No staff member was present or using the cart at the time of the observations. When approached, an LVN stated she did not know who was responsible for the cart, but acknowledged that it should have been locked when not in use and proceeded to secure it. Interviews with staff confirmed that the expectation was for all medications, including those at the bedside, to be secured and reported if found otherwise. The DON and Administrator both stated that the facility's policy required medication carts to be locked when not in direct use, and that all nursing staff were responsible for ensuring this. Review of facility policy and staff training materials further supported the requirement that medication carts not be left unlocked and unattended.