Unsecured Medication Storage in Resident Room
Penalty
Summary
Facility staff failed to ensure that all drugs and biologicals were stored in locked compartments and only accessible to authorized personnel, as required by state and federal regulations. During an observation, a cognitively intact female resident with dementia, osteoporosis, and a recent femur fracture was found with a plastic container of over-the-counter medications, including Voltaren cream, Pepto Bismol chewable tablets, saline nasal spray, Icy Hot pain relief cream, and Mentholatum ointment, on her bedside table. The resident stated the medications were kept there for her use, but her care plan did not indicate she was permitted to self-administer medications. Interviews with nursing staff, the DON, and the Executive Director confirmed that the resident was not authorized to self-administer medications and that medications should not be left in her room. Staff also noted that family members sometimes brought items, including medications, into the resident's room. The facility's medication storage policy requires nursing staff to maintain secure storage of all medications, which was not followed in this instance.