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F0761
E

Failure to Properly Label and Store Insulin Medications

Fremont, Ohio Survey Completed on 06-03-2025

Penalty

Fine: $26,685
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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

Surveyors observed that the facility failed to store and label insulin medications in accordance with professional standards and facility policy. Multiple insulin pens and vials prescribed to nine residents were found either without the date they were opened or being used beyond their recommended expiration period after opening. Specifically, several insulin pens and vials, including Lantus, aspart, lispro, Semglee, and glargine, were discovered on various medication carts and in storage rooms without proper dating or with dates indicating use past the 28-day expiration period as outlined in pharmacy guidance. Staff interviews confirmed awareness of the pharmacy's instructions and facility policy requiring opened insulin to be dated and not used beyond the specified period, yet these procedures were not consistently followed. The facility's own policies, as well as pharmacy guidance available on medication carts, required nursing staff to mark insulin vials and pens with the date opened and to check expiration or beyond-use dates prior to administration. Despite this, observations revealed that insulin for several residents was either not dated when opened or continued to be used after the expiration date. Staff, including LPNs and an RN, acknowledged these lapses during interviews, and the Director of Nursing confirmed that insulin vials and pens are to be marked with the date opened to prevent administration of expired medications.

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