Medication Labeling, Storage, and Access Deficiencies Identified
Penalty
Summary
Surveyors identified multiple failures in the facility's medication management practices, specifically regarding the labeling and storage of drugs and biologicals. Observations revealed that several opened vials and pens of insulin (Levemir, Lantus, Lispro) and Tuberculin Purified Protein Derivative (PPD) were found in medication carts and rooms without proper labeling or dating. In some cases, staff were unable to identify the owner of the medication or when it had been opened, and some medications were found to be expired. Additionally, an opened and unlabeled bottle of an over-the-counter antifungal medication was found, and a Lispro insulin pen was improperly stored on a shelf instead of in the refrigerator or medication cart as required. Temperature monitoring of medication refrigerators was also deficient. The temperature log for the medication refrigerator showed multiple dates with missing documentation of temperature readings and staff signatures. The Assistant Director of Nursing (ADON) stated that housekeepers were responsible for monitoring refrigerator temperatures, but acknowledged that they may not have had pens to record the readings, resulting in incomplete logs. This practice deviated from the facility's policy, which required daily temperature documentation by nursing staff. Access to medication rooms was not restricted to authorized personnel. An Environmental Aide (EA) was observed obtaining keys from a nurses' station drawer and entering the medication room unsupervised to retrieve residents' cigarettes. The EA reported that this had been standard practice since employment, with keys always accessible in the nurses' station. The Director of Nursing (DON) confirmed that only nurses and Certified Medication Technicians (CMTs) should have access to medication rooms, and non-licensed staff should not enter these areas.