Medication Cart Left Unlocked and Unattended During Medication Pass
Penalty
Summary
A deficiency occurred when a medication cart was left unlocked and unattended by an LPN during medication administration on multiple occasions. The medication cart, which contained drugs and biologicals, was observed by a surveyor to be left open and unattended in the 200 wing and outside the dining room, with the drawers facing the hallway and exposed during the medication pass. Multiple residents were observed walking or wheeling past the unattended cart, increasing the risk of unauthorized access. The facility's policy, dated January 2023, requires that medication carts remain locked when not in use or when not attended by authorized personnel. During interviews, the LPN acknowledged that the cart should not have been left unlocked and stated that it was usually locked but was forgotten on these occasions. The DON also confirmed that medication carts are required to be locked when unattended.