Failure to Securely Store Medications and Monitor Refrigerator Temperatures
Penalty
Summary
Facility staff failed to ensure that drugs and biologicals were stored in a safe and secure manner, as required by facility policy and professional standards. Observations and review of temperature logs for medication refrigerators at both the North and South nurse stations revealed multiple dates across October, November, and December where daily temperature checks were not recorded. The Director of Nursing confirmed that temperatures had not been monitored and logged daily, despite facility policy requiring daily monitoring of medication refrigerator temperatures. Additionally, during medication administration for a resident with multiple diagnoses including emphysema, hypertension, hepatitis C, and cognitive impairment, an LPN left three medication cards unsecured on top of a medication cart in the hallway, out of view, while administering medications in the resident's room. Later, the same resident was found with two inhalers (Ventolin and Symbicort) by his pillow, despite not being permitted to self-administer medications. Both the LPN and the DON confirmed that these medications should not have been accessible to the resident and should have been securely stored.