Expired Medications and Improper Medication Administration Observed
Penalty
Summary
Surveyors identified two deficiencies related to medication management. First, during an observation of the overstock medication room, seven unopened bottles of Folic Acid 400 mcg were found with an expiration date of 02/2025, indicating they were expired. This was confirmed by a registered nurse, and facility documentation showed that Folic Acid 400 mcg was kept as over-the-counter stock. Facility policy requires that expired medications be destroyed or returned according to pharmacy guidelines, but these expired bottles remained in storage. Second, a review of records and observation for a resident with diagnoses including diabetes, cerebral infarction, edema, and hypertension revealed that a dose of Hydralazine, prescribed for hypertension, was left in a pill cup on the resident's bedside table. The medication had been signed as administered by the night shift nurse, but the resident reported that nurses sometimes left medications at the bedside without observing ingestion, especially when she was sleepy. This was verified by a registered nurse, who acknowledged that medications should not be left at the bedside and that administration should be observed.
Plan Of Correction
F761 The facility failed to ensure proper storage and handling of medications when medications were observed at the bedside of resident #28. B) Failed to remove seven bottles of expired Folic Acid from the OTC medication storage cabinet. Step 1: The facility RN Supervisor immediately A) secured the medications noted at bedside of resident #28, notified the PCP with no new orders, and assessed the affected resident with no negative findings. The RN #241 responsible for not properly securing (leaving at bedside) said medications was educated and disciplined by the DON. Completed on 6/2/25. B) The facility DON removed the expired folic acid from storage and disposed of on 6/4/25. Step 2: This has the potential to affect all residents; current medications in stock were audited for expiration dates and proper storage/properly secured by the DON on 6/13/25 with no negative findings. Step 3: To prevent this from recurring, the DON or designee will educate licensed nurses and the Central Supply Designee on the proper policy and procedure for labeling, securing, storage, handling, and (for nurses) administration of medications and biologic agents. Completed on 7/11/25. Step 4: To monitor and maintain ongoing compliance, the DON or designee will audit medications for proper labeling, storage, and handling 2x per week x4 weeks then 2x per month x2 months. Audits will begin 7/14/25. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.