Improper Refrigeration, Labeling, and Disposal of Medications
Penalty
Summary
Surveyors identified that medications were not stored and labeled according to professional standards and facility policy. Lorazepam Injection Solution 2 mg/mL for resident R136 was found in the controlled substance narcotics drawer of the medication cart at 11:14 AM, unrefrigerated, despite a sticker on the packaging instructing that it be kept refrigerated. The LPN (V13) confirmed that the medication should be refrigerated per the manufacturer’s instructions to maintain patency. Physician orders showed that this lorazepam injection had been discontinued on a prior date, yet it remained in the cart. Similarly, at 11:21 AM, Lorazepam Oral Concentrate 2 mg/mL for resident R137 was observed unrefrigerated in the narcotics drawer, also labeled to be kept refrigerated, and the LPN (V23) confirmed it should be refrigerated. Physician orders documented that this lorazepam oral concentrate had also been discontinued on a prior date but was still present in the cart. At 11:25 AM, additional medication storage and labeling issues were observed in the medication cart with LPN V23. Opened multi-dose insulin vials for residents R70 (Humalin solution), R42 (Humalog), and R51 (insulin lispro) were found without an open date or expiration/discard date. Another opened vial of Insulin Aspart for resident R107 was labeled with a discard date of 7/23, which V23 acknowledged as expired and removed from the cart. V23 affirmed that all multi-dose insulin vials and pens are to be labeled with the open date and discard date and stated that insulin is generally good for 28 to 30 days after opening. The DON (V2) confirmed that facility expectations are that liquid lorazepam is stored in the refrigerator, all multi-use insulin containers are labeled and dated when opened, and discontinued medications are removed from the cart. Facility policies on labeling/dating medications and medication storage require dating of insulin when first opened, refrigeration of medications requiring 36–46°F, and immediate withdrawal and disposal of outdated or deteriorated drugs.
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