Failure to Label Open Dates on Inhalation Medications
Penalty
Summary
Staff failed to label the open date on inhalation medications for two residents with severe cognitive impairment and chronic respiratory conditions. For one resident with type II diabetes mellitus and chronic respiratory failure, the ipratropium-albuterol inhalation solution was being administered every six hours, but the opened foil pouch containing the unit-dose vials was not labeled with the date it was first opened. Similarly, for another resident with chronic obstructive pulmonary disease, congestive heart failure, and muscle weakness, the albuterol inhalation solution was also being administered every six hours, and the opened foil pouch was not labeled with the date of opening. In both cases, the lack of labeling was observed during a medication cart inspection, and the responsible nurse confirmed that the pouches should have been dated according to manufacturer instructions. Manufacturer guidelines for these medications specify that once the foil pouch is opened, the vials must be used within a specific timeframe (one week for ipratropium-albuterol and two weeks for albuterol). The facility's policy also requires checking expiration dates and returning expired medications to the pharmacy. The DON confirmed that the medications should be dated upon opening and that failure to follow these guidelines could affect medication effectiveness. The deficiency was identified through observation, interview, and record review, with direct evidence that the required labeling was not performed.