Medication Storage and Administration Deficiencies Identified
Penalty
Summary
Surveyors identified multiple deficiencies related to medication management within the facility. During an observation of the medication storage room, expired stock medications intended for resident use were found, including Tylenol, enteric coated Aspirin, Geri Max antacid, and Docusate Sodium. The Unit Manager and Supply Coordinator confirmed the presence of these expired medications and acknowledged that expired drugs should have been removed and disposed of according to facility policy. Additionally, the medication storage refrigerator was found to be operating at 50°F, above the recommended range for medication storage, with water pooling inside. Several temperature-sensitive medications, such as insulin and Micafungin injection, were stored in this refrigerator, contrary to manufacturer recommendations. Further investigation revealed that a resident with a history of hemiplegia, epilepsy, insomnia, anxiety, and diabetes had medications left unsecured at the bedside by an LPN, without confirmation of administration. The resident reported that this was a recurring practice by the nurse, and interviews with staff and the resident's responsible party corroborated that medications were left at the bedside overnight and not administered as intended. The Medication Administration Record indicated the medications were signed as given, but there was no documentation of the missed doses or notification to the physician or family regarding the incident. The facility's failure to ensure medications were not expired, were stored at appropriate temperatures, and were not left unsecured at the bedside without proper administration or documentation affected at least one resident and had the potential to impact all residents. These findings were confirmed through observation, interviews with staff and residents, and review of facility policies and records.