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F0761
D

Failure to Store and Manage Medications per Manufacturer and Facility Policy

Kalamazoo, Michigan Survey Completed on 06-04-2025

Penalty

Fine: $80,30015 days payment denial
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Facility staff failed to store and manage medications according to manufacturer instructions and facility policy. During medication administration, a registered nurse was observed using an insulin pen that had been opened 38 days prior, despite manufacturer guidelines stating it should be discarded 28 days after opening. Additional insulin pens on the medication cart were found to be opened for 51 and 33 days, both exceeding the facility's policy of discarding after 30 days. The unit manager confirmed that monitoring medication storage was assigned to the third shift, but acknowledged that all nurses should check expiration dates before administering medications. It was also noted that knowledge of insulin pen disposal was not included in the facility's orientation education. Further observations revealed an inhaler left out in a resident's room instead of being stored in the medication cart, and the medication cart itself was disorganized, with medication cards not alphabetized or separated by room. Another inhaler was found in the cart without an open date, making it impossible to determine if it was still within the 6-week usage period specified by the manufacturer. Review of facility policies confirmed that medications are to be stored per manufacturer recommendations and that medication carts should be kept clean and organized, with expiration dates checked prior to administration.

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