Improper Storage of Topical Medication
Penalty
Summary
A deficiency occurred when a container of zinc oxide cream, prescribed for skin irritation and incontinence care, was left on top of a resident's bedside table rather than being stored in a locked or secured compartment. The resident involved had a history of Alzheimer's disease, delusional disorder, and depression, with moderate cognitive impairment as indicated by a BIMS score of 10. The resident required assistance with incontinence care and was prescribed multiple medications, including antidepressants and hypnotics. There was no documentation indicating that the resident requested the barrier cream be left out, and the facility's policy required all drugs and biologicals, including those for external use, to be stored securely. Observations confirmed that the zinc oxide was accessible to the resident, who was in bed at the time, and staff interviews acknowledged that the cream should not have been left within reach due to the risk of ingestion, especially for residents with cognitive impairment. Staff members, including a CNA, ADON, DON, and the Administrator, all recognized that the cream should have been secured after use, in accordance with facility policy. The failure to properly store the medication was not in line with accepted professional principles and facility policy, as confirmed by both observation and staff statements.