Deficient Medication Labeling and Storage Practices
Penalty
Summary
Surveyors identified deficiencies in the facility's medication labeling and storage practices. During a medication administration observation, a nurse prepared furosemide for a resident with congestive heart failure and atrial fibrillation. The nurse stated that the medication should be held if the resident's systolic blood pressure was below 110 mmHg, as per the physician's order. However, the medication label did not include the required holding parameter, and there was no direction change sticker to indicate this instruction. The Director of Nursing confirmed that the pharmacy should have updated the label to reflect the physician's order. Further inspection of the medication storage area revealed additional issues. Three bottles of iron tablets with expiration dates of April 2025, an opened container of Metamucil labeled for a discharged resident with an expiration date of November 2024, and an open bottle of ProStat with dried liquid residue were found stored in the medication cabinet. These items were readily available for use despite being expired, labeled for a discharged resident, or showing signs of contamination. The Director of Nursing acknowledged that these medications should not have been stored in the cabinet and could potentially be administered in error. A review of the facility's policy indicated that medication labeling must include appropriate instructions and precautions, and only the dispensing pharmacy may alter medication labels. The policy also requires that discontinued, outdated, or deteriorated medications be returned or destroyed according to pharmacy instructions. The facility failed to adhere to these policies, resulting in improper labeling and storage of medications and biologicals.