Unattended Medication Left in Hallway
Penalty
Summary
A deficiency occurred when medication intended for a resident with multiple diagnoses, including stroke, hypertension, dementia, and prostate cancer, was found unattended in a medication cup on top of an isolation cart outside the resident's room. The unattended medication included several pills and a bottle of nasal spray. At the time of discovery, no staff or residents were present in the vicinity of the medication. The medication was later identified as belonging to the resident, who had moderate cognitive impairment as indicated by a BIMS score of 10 out of 15. Facility policy requires that medications be under the direct observation of the person administering them or locked in a storage area or cart during medication administration. However, the medication was left unattended, in violation of this policy. The resident was later observed in the dining room and could not confirm whether he had received his medication that morning. The incident was confirmed through observation, interview, and record review.