Improper Medication Labeling and Storage
Penalty
Summary
Surveyors identified multiple failures in the facility's medication management practices, specifically regarding the labeling and storage of drugs and biologicals. During inspections of various medication storage areas, including medication carts, IV carts, treatment carts, and the medication room, surveyors observed that discontinued and expired medications were not removed from active stock. For example, a discontinued blister card of calcium acetate capsules prescribed for a resident was found stored with active medications, despite the order having been changed weeks prior. The responsible nurse confirmed the medication should have been removed and disposed of according to facility policy. Further observations revealed expired medications and devices stored in several locations. An insulin pen for a resident was found in the medication cart beyond its 28-day in-use period, and multiple expired heparin lock flush syringes and a bottle of Adapt Stoma Powder were found in the IV cart, treatment cart, and medication room. Staff interviews confirmed awareness that these items were expired and should have been disposed of in the pharmaceutical waste bin, as outlined in facility policies and manufacturer instructions. Additionally, surveyors found issues with the labeling of expiration dates and beyond-use dates (BUD) on IV diluent bags and compounded IV medications. IV bags stored outside of their protective overwrap lacked appropriate BUD documentation, and compounded ceftriaxone IV bags were labeled with incorrect expiration dates, exceeding the maximum storage time allowed by USP <797> standards. The emergency medication kit also had an incorrect expiration date on its exterior label, not reflecting the earliest expiration date of its contents. These findings were confirmed through interviews with pharmacy staff and review of facility policies.