Failure to Secure Medications and Maintain Safe Refrigeration Temperatures
Penalty
Summary
The facility failed to ensure that medications and biologicals in the medication room were securely stored and maintained at safe refrigeration temperatures. During an observation, it was found that some storage cupboards in the medication room were either not locked or lacked locks entirely, including cupboards containing stock medications and bins labeled for medication destruction. Additionally, the medication room was observed being left open and unattended by staff, contrary to facility policy requiring medication rooms to be locked when not in use. The medication refrigerator, which contained immunizations, GLP-1 injectables, insulin, and controlled medications, was found to be locked but had an internal temperature of 48 degrees Fahrenheit, exceeding the safe storage range. The temperature log for the fridge was incomplete, with several missed entries over multiple months. The facility's policy required that all compartments containing drugs and biologicals be locked when not in use and that medication refrigerator temperatures be maintained between 36 to 46 degrees Fahrenheit. Despite these requirements, the medication fridge was repeatedly found out of range, and temperature documentation was inconsistent. The consulting pharmacist later recommended destruction and replacement of several medications stored in the fridge due to the unsafe temperature. No residents were reported to have received medications from the affected fridge after the temperature deviation was discovered.