Unsecured Medications Left at Bedside in Resident Room
Penalty
Summary
The facility failed to ensure that the resident environment was free from potential accident hazards on one of its nursing units. Specifically, in one resident's room, five clear plastic cups containing a total of seven tablets and two capsules were found unsecured on the bedside table. These medications were accessible in an open room, which could have allowed other residents to access them. The medications included Tylenol 325 mg tablets, a cranberry 300 mg tablet, and oxycodone HCl 5.0 mg capsules. The presence of these medications at the bedside was in direct violation of the facility's policy, which requires that a nurse or qualified staff remain with the resident until medications are ingested. A review of the resident's clinical record indicated that the individual was not deemed safe to self-administer medications, as they required nursing assistance and could not state the purpose, dosage, or timing of their medications. The medications were supposed to be maintained and administered by nursing staff. The DON confirmed both the presence of the medications and that the oxycodone was dispensed in a different form than ordered. These findings were corroborated by facility policy and staff interviews.