Unsecured Topical Medications Left in Bathroom of Residents With Dementia
Penalty
Summary
Surveyors found that two roommates with dementia and/or wandering tendencies, residing on a secure unit, had multiple prescribed topical medications left unsecured in their shared bathroom. During an environmental observation, diclofenac sodium 1% gel, Eucerin cream, miconazole nitrate powder, and triamcinolone cream were observed in the bathroom designated for these two residents’ use. These medications had active prescriber orders with various start dates and were not stored in a locked medication cart or locked nurse office as required. Record review showed that neither resident had a Self Administration of Medication (SAM) authorization on file for any of the observed medications. In interviews, the DON and IDON confirmed that all medications, including creams, powders, and other topicals prescribed by a practitioner, are required to be locked and are not to be left out under any circumstance. The presence of these unsecured medications in the residents’ bathroom, combined with the absence of SAM documentation, constituted a failure to maintain an environment free from accident hazards and to provide adequate supervision to prevent accidents.
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