Failure to Label and Date Multi-Use Ophthalmic Medications
Penalty
Summary
Surveyors identified a deficiency in the facility’s handling and labeling of multi-use ophthalmic medications on two medication carts. On one occasion, a CMA administered TheraTears eye drops to a resident with dry eye syndrome; the bottle showed a manufacturer expiration date of 01-2027 but was not labeled with an open date, despite manufacturer instructions to discard 45 days after opening. The resident’s active physician orders instead listed Refresh Liquigel Ophthalmic Gel 1% for dry eye syndrome of bilateral lacrimal glands. During inspection of the Hall 600 medication cart with the same CMA, surveyors observed open, undated bottles of Latanoprost 0.005% eye drops for a resident with ocular hypertension and Pataday allergy eye drops for a resident with dry eye syndrome whose active orders also specified Refresh Liquigel Ophthalmic Gel 1%. The CMA stated that all eye drop solutions should be labeled with the open date and discarded 30 days after opening or per manufacturer instructions, and acknowledged that giving expired medication may not be effective and could be a source of infection. On the Hall 100 medication cart, surveyors observed an open, undated bottle of Latanoprost 0.005% eye drops for a resident with glaucoma, during an observation with an LVN. The LVN reported that the eye drops were administered by evening shift nurses and that she was not the one who opened the bottle, but confirmed that eye drops should be labeled with the open date and discarded 30 days after opening or according to manufacturer labeling, and that failure to do so could result in ineffective medication or infection. In an interview, the DON stated that once a multi-use vial or bottle is opened, staff are required to date it and discard it 30 days after opening unless otherwise directed by the manufacturer, and that all medications must be labeled. The DON further stated that opened TB PPD vials must be dated and discarded after 30 days to prevent use of expired medication, and that use of medication solutions beyond their post-opening expiration could be a source of infection. The facility’s “Storage of Medications” policy stated that discontinued, outdated, or deteriorated drugs or biologicals shall not be used and must be returned to the pharmacy or destroyed, and that nursing staff are responsible for maintaining medication storage.
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