Medication Storage, Labeling, and Disposal Deficiencies
Penalty
Summary
Surveyors identified multiple deficiencies related to the storage, labeling, and disposal of medications and biologicals. An expired box of hemorrhoid ointment was found in a medication cart, and the LVN confirmed it should have been removed. Additionally, an opened multi-dose vial of insulin for a resident with diabetes was not labeled with the date it was opened, contrary to facility policy and manufacturer instructions, which require insulin vials to be dated and discarded after 28 days. The DON confirmed that staff are expected to inspect medication carts weekly and ensure expired medications are removed, and that insulin vials must be labeled with the opened date. Observations also revealed that medications were not securely stored as required. One resident had a Fluticasone Propionate nasal spray on their bedside table without a physician's order for bedside storage, and another resident had multiple eye drops and two vials of insulin on their bedside table. Both residents stated that staff had provided the medications, and the DON confirmed that medications should not be kept at the bedside unless there is a physician's order and care plan for self-administration. Facility policy requires all medications to be kept in locked compartments unless otherwise ordered and documented. A further deficiency was noted when an LVN discarded a tablet of Oxycodone, a controlled substance, into a medication waste bin without a witness after it was dropped. Both the DON and pharmacy consultant confirmed that controlled substances must be wasted in the presence of another licensed nurse, as per facility policy. The lack of proper witnessing and documentation for the disposal of controlled substances was a direct violation of the facility's procedures.