Unattended Medication Cart Left Unlocked in Resident Area
Penalty
Summary
A deficiency was identified when a medication cart (Med Cart 1) was observed unlocked and unattended in a common area near the nurses' station, across from the elevator on the second floor. The cart contained both over-the-counter and resident medications. During the time the cart was left unlocked, multiple residents, including one in a wheelchair who made physical contact with the cart, were present in the vicinity. Staff members, including a CNA and a housekeeper, were also nearby, and several residents were observed walking around the area. The nurse assigned to the cart confirmed that it was not supposed to be left unlocked and acknowledged the presence of mobile and ambulatory residents in the halls. Interviews with facility leadership, including the ADON and DON, confirmed that the facility's policy requires medication carts to be locked when unattended, and that the responsibility for securing the cart lies with the assigned nurse or medication aide. Both leaders emphasized the importance of keeping medication carts locked due to the presence of residents who may not be fully alert and oriented, and the potential for unauthorized access to medications and supplies. Review of the facility's policy corroborated these expectations, stating that all drugs and biologicals must be stored in locked compartments.