Unattended and Unlocked Medication Carts, Undated and Improperly Stored Medications
Penalty
Summary
Facility staff failed to keep treatment and medication carts locked when unattended, as observed on one of two nursing units during a complaint survey. An unlocked and unattended treatment cart was found in front of the nurse's station, containing prescription creams, ointments, dressing supplies, and a bottle of sterile water irrigation with no date indicating when it was opened, despite sterile water being usable for only 24 hours after opening. Additionally, an unlocked and unattended medication cart was found in the hallway, with a resident standing at the cart and no nursing staff present. The surveyor was able to access the cart, which contained insulin pens, syringes, and a cell phone. Multiple insulin vials and pens for several residents were found opened but not dated, contrary to manufacturer instructions that require insulin to be used within 28 days of opening. Some unopened insulin pens were stored in a plastic bag labeled for refrigeration until opened, but there was no indication that opened pens were being refrigerated as required. Facility policy requires all compartments containing drugs and biologicals to be locked when not in use and mandates refrigeration for medications that require it. These deficiencies were confirmed through observation, staff interviews, and review of facility policy.