Improper Storage and Labeling of Medications and Unsanitary Medication Room Conditions
Penalty
Summary
Surveyors identified that the facility failed to ensure all drugs and biologicals were properly stored and labeled in two of three medication carts and one of two medication storage rooms. Specifically, insulin pens (Humalog, Lantus, and Semgee) and an Ozempic pen were found in medication carts without open dates, contrary to manufacturer instructions and facility policy, which require labeling with the date opened to ensure medications are not used past their safe period. Additionally, the vaccine storage refrigerator contained both vaccines and insulin, which is not in accordance with proper storage practices. Further observations in the medication storage room revealed unsanitary conditions, including a large trash bin filled with trash, a basket with used gloves and food wraps, a non-working bidet filled with plastic and paper scraps, and a box with filled sharps containers. The room also contained a deflated air mattress in a dusty sink, an empty bucket, a brush, and a broken walker. The countertop was stained and dusty, and the controlled emergency medication box was stored on top. These conditions do not meet standards for sanitary storage of medications and supplies. In one medication cart, a basket was found containing seven inhalers, some missing mouthpiece covers and two without resident names, which is not compliant with labeling and sanitary storage requirements. Interviews with nursing staff revealed a lack of knowledge regarding the importance of labeling insulin pens and proper storage of inhalers. Staff were also unaware of the specific timeframes for safe use of medications after opening, and could not locate the binder with medication expiration dates.