Medications Left Unsecured and Unattended in Resident Rooms
Penalty
Summary
Facility staff failed to ensure that medications were securely stored and not left unattended, as required by professional standards and facility policy. In one instance, a Trelegy Ellipta inhaler prescribed for a resident with asthma, diabetes, and other chronic conditions was found unsecured on the resident's bedside table. The resident had not been assessed or authorized for self-administration of medications, and both the LPN and the DON confirmed that medications should not be left at the bedside unless the resident is assessed and has a physician's order for self-administration, with medications kept in a locked box. Additionally, on another occasion, an LPN prepared oral medications for two residents and left them on their bedside tables while the residents were in the dining room. The LPN admitted to leaving the medications unattended to expedite her medication pass, despite knowing this was against facility policy. One resident reported taking the medication upon returning to her room, while the other was later observed by the LPN taking the prepared medication. There was no documentation or assessment indicating that either resident was permitted to self-administer medications. Facility policy clearly states that medications must be administered within 60 minutes of the scheduled time, medication carts must be locked when not in use, and residents must be observed to ensure medication ingestion. The DON and staff development coordinator confirmed that these policies were not followed in the incidents described, and that medications should not be left unsecured or unattended in resident rooms.