Medication Cart Security and Labeling Deficiencies
Penalty
Summary
A deficiency was identified when a nurse failed to lock a medication cart on a secured unit while it was unattended. The nurse entered a resident's room and was engaged in conversation for approximately ten minutes with the privacy curtain pulled, leaving the medication cart out of her line of sight and unlocked. The nurse acknowledged being distracted and not realizing the cart was left unsecured, despite the presence of narcotics on the cart and the risk posed by residents with dementia. Additionally, two Albuterol Sulfate Inhalation Solution vials on the same medication cart were found to be undated after being opened. The nurse was unable to determine who had opened the vials and stated that it was the responsibility of the person opening the medication to date it. Facility policies reviewed indicated that medication carts must be locked when not in use and that medications must be labeled with the date dispensed and expiration date when applicable.