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F0880
E

Improper Storage of Insulin Pens Leading to Cross-Contamination Risk

Saint Paul, Minnesota Survey Completed on 08-28-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Insulin pens prescribed for multiple residents were observed to be stored together in a single plastic cup within medication carts on the transitional care unit (TCU), with no barriers separating the pens. Registered nurses reported that this method of storage had been the standard practice, with insulin pens for different residents placed together and touching, without any separation. Staff members, including RNs and the director of nursing, indicated they were unaware that insulin pens should be stored separately to prevent cross-contamination. The infection preventionist confirmed that each resident's insulin pen should be separated from others to avoid possible cross-contamination. Facility policy on insulin administration and medication storage indicated that contamination of insulin pens can occur externally, even without visible blood, and referenced the need to follow manufacturer recommendations for storage. Despite these policies, the observed practice did not align with the stated requirements, as insulin pens for different residents were stored together, creating a potential for cross-contamination.

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