Insulin Pens Not Dated Upon Opening in Medication Cart
Penalty
Summary
Surveyors identified that the facility failed to ensure all drugs and biologicals were properly labeled and stored according to professional standards for two residents. Specifically, insulin pens for two residents with diabetes were found in a nursing cart without open dates, which is necessary to determine when the insulin should be discarded. Both insulin pens, Lantus Solostar and Novolog Flex Pen, were observed without open dates during a medication cart inspection. For one resident, a male with diagnoses including dementia, type 2 diabetes mellitus, hypokalemia, and heart failure, the insulin Lantus Solostar pen was found without an open date. The resident's medication administration records confirmed regular insulin administration as ordered by the physician. Interviews with nursing staff, including an agency LVN and a regional RN, revealed that the absence of an open date made it unclear when the insulin should be discarded, as the standard is to discard 28 days after opening. The staff were unable to determine if the insulin was still safe for use. Similarly, for a female resident with cerebral atherosclerosis, dementia, type 2 diabetes mellitus, heart failure, and hypertension, a Novolog Flex Pen was found without an open date. The medication administration record showed the resident was receiving insulin as ordered. Interviews with staff confirmed that the insulin should have been dated upon opening, and the lack of an open date prevented staff from knowing when to discard the pen. The ADON acknowledged that nurses are responsible for labeling insulin with open dates, but there was no facility policy in place regarding this practice.