Failure to Securely Store Medications and Biologicals
Penalty
Summary
Facility staff failed to store drugs and biologicals in locked compartments as required by state and federal regulations. During observations, surveyors found that medicated creams (zinc oxide), a vial of nebulizer solution, and a tube of topical pain reliever were left inside the rooms of four residents. These items were visible and accessible on top of drawers or side tables, rather than being secured in medication carts or locked storage. Staff interviews confirmed that these medications were not supposed to be left in resident rooms and should have been removed after use. The residents involved had various medical conditions, including hemiplegia, hemiparesis, dementia, incontinence, chronic obstructive pulmonary disease, and pain management needs. All residents were cognitively intact according to their BIMS scores. The medications found included zinc oxide for incontinence care, a solution for breathing treatments, and a topical pain reliever for shoulder pain. Staff members acknowledged that these medications were left in the rooms after care was provided and that they did not notice them during their rounds. Interviews with CNAs, an LVN, the ADON, and the DON revealed a lack of adherence to the facility's medication storage policy, which requires all medications and biologicals to be stored securely and only accessible to authorized personnel. Staff admitted they did not know who left the medications in the rooms and recognized that medications should not be left accessible to residents. The facility's policy, reviewed by surveyors, clearly states that medications must be stored safely and securely, accessible only to licensed nursing or authorized staff.