Improper Medication Labeling and Insecure Storage of Drugs and Biologicals
Penalty
Summary
Surveyors identified that multiple medications and biologicals on a medication cart were not labeled or stored according to facility policy and professional standards. During an inspection of medication cart #3 with the ADON, open bottles of antacid/anti-gas for one resident, Levetiracetam (Keppra) solution for another resident, Lactulose solution for a third resident, and Valproate Sodium oral solution for a fourth resident were found without open dates. Several stock medications and biologicals on the same cart, including Geri-Tussin DM, Polyethylene Glycol 3350, and Reguloid, were also open without open dates. Additionally, a container holding approximately 1/4 cup of an unlabeled white powder, identified by the ADON as liquid thickener, was missing its snap-on lid and had no label or date. The ADON acknowledged that she does not date all medications when opened and stated that the white substance should have been properly contained. The DON stated that all open medications are required to have an open date and that all containers should be labeled to identify their contents, consistent with the facility’s Medication Storage policy, which requires dating when the manufacturer’s seal is broken and sets a 30-day expiration unless otherwise specified. Physician orders confirmed that the undated open medications on the cart were active orders for the respective residents, including Valproate Sodium for agitation/anxiety, Keppra for epilepsy, Lactulose for toxic encephalopathy, and Maalox Max for indigestion. The facility’s written policies also required medications and biologics to be stored safely, securely, and properly. Surveyors also observed failures in secure storage and control of medications at the bedside and in resident rooms. One resident with diagnoses including COPD, cataract, myopia, dementia, major depressive disorder, anxiety, and polyarthritis had a nebulizer machine and two unopened vials of Albuterol Sulfate for inhalation on the bedside table and reported independently adding the medication to the machine and administering treatments daily without nursing supervision. The DON stated there were no residents authorized to self-administer medications and that no medications should be stored at the bedside without an order; the resident’s orders did not include bedside storage. Another resident had a medication cup at bedside containing a small white pill marked “AC 145,” which she believed might be for high blood pressure; her orders included Chlorthalidone 25 mg daily for hypertension. A separate resident’s unlocked in-room refrigerator contained Fluticasone Propionate nasal spray ordered for nightly use, despite the facility’s policy that medication supplies are accessible only to licensed nursing, pharmacy personnel, or staff lawfully authorized to administer medications.
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