Expired Vaccines, Undated Insulin, and Loose Pills Found During Medication Storage Audit
Penalty
Summary
Surveyors identified multiple deficiencies related to the storage and labeling of drugs and biologicals. In one medication room, five unopened and two opened vials of influenza vaccine were found in the refrigerator, all labeled with an expiration date that had already passed. These expired vials were still available for use. The Unit Manager acknowledged that the expired vials should have been returned to the pharmacy after expiration. The Infection Preventionist, who is responsible for weekly checks of medication rooms, stated she had recently checked the room but did not observe the expired vials. The Director of Nursing confirmed that the Infection Preventionist is tasked with removing expired medications during weekly checks and after resident discharges, and expressed surprise that the expired vials were present, as no flu shots had been administered since the end of the previous flu season. Additionally, in a medication cart, an opened insulin pen was found without a date indicating when it was opened, despite manufacturer instructions that the pen expires 28 days after opening. The nurse responsible for the cart admitted the pen should have been dated and was unaware of its status. In the same cart, a plastic cup containing 18 loose pills labeled with a resident's name was found in the narcotic drawer. The nurse stated she did not place the loose pills there and had not noticed them during narcotic counts. The Director of Nursing confirmed that loose pills should not be kept in medication carts and that daily checks are required.