Expired Medications and Supplies Not Removed from Storage and Carts
Penalty
Summary
Surveyors observed that the facility failed to ensure drugs and biologicals were properly labeled and discarded when expired, as required by facility policy and professional standards. During observations of two medication carts and the medication storage room, expired medical supplies and medications were found, including medical supplies with expiration dates of 12/31/2024 and 04/13/2025, bottles of cholecalciferol (Vitamin D) and folic acid with expiration dates of 06/2025, and a box of Nicorette gum with an expiration date of 01/2025. Staff present during these observations confirmed that the items were expired and acknowledged they should have been removed. Interviews with staff revealed uncertainty regarding the facility's policy and procedures for checking and removing expired medications. One staff member indicated that pharmacy staff are responsible for reviewing medication carts but was unsure how often this occurred. Another staff member stated that charge nurses are supposed to audit medication carts to ensure expired medications are removed, and that both nurses and pharmacy staff should be involved in this process. The facility's policy requires expired medications and biologicals to be stored separately until destroyed or returned to the pharmacy, but this was not followed as evidenced by the expired items remaining on the carts and in the storage room.