Medications Left Unattended and Unlabeled with Resident
Penalty
Summary
A deficiency occurred when a cognitively intact resident, admitted with multiple chronic conditions including COPD, diabetes, chronic pancreatitis, chronic kidney disease, hypertension, and atherosclerotic heart disease, was observed ambulating in the hallway holding a souffle cup containing seven tablets and capsules. The resident reported that the nurse had given the medications over an hour prior but was unable to identify the medications when asked. The resident subsequently left the medications with the surveyor and walked away. Interviews with facility staff revealed that the nurse had prepared and delivered the medications to the resident, but left the room due to an emergency involving another resident. The nurse did not return to ensure the medications were taken, contrary to facility policy, which requires staff to remain with the resident to ensure medications are swallowed. The DON confirmed that staff should not leave medications at the bedside and should explain the medications to the resident.