Failure to Discard Expired Multi-Dose PPD Vial Used for TB Testing
Penalty
Summary
The deficiency involves the facility’s failure to follow pharmaceutical procedures for multi-dose medications, specifically a vial of Tuberculin Purified Protein Derivative (PPD) stored in the medication room refrigerator for Halls 600-700-800. During an observation with an LVN, surveyors found an open vial of PPD that had been dated more than 30 days earlier, indicating it had not been discarded within the required timeframe. Review of six residents’ immunization records showed that all six had received TB skin tests using PPD from the same lot number as the expired vial on various dates after the 30-day period had passed. In interviews, the LVN responsible for infection prevention stated she performed all TB skin tests, had opened and dated the PPD vial, and acknowledged that facility practice required dating the vial upon opening and discarding it 30 days later. She admitted she forgot to discard the vial and continued to use it beyond 30 days. The DON confirmed that all multi-use vials must be dated when opened and discarded after 30 days unless manufacturer instructions differ, and that all medications must be labeled and checked by nurses for expiration and proper storage. Review of the facility’s “Storage of Medications” policy showed it prohibited the use of discontinued, outdated, or deteriorated drugs or biologicals and assigned nursing staff responsibility for maintaining medication storage, which was not followed in this instance.
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