Unsecured Medications Left Unattended in Resident Room
Penalty
Summary
The deficiency involves unsecured medications left unattended in a resident's room and not stored in locked compartments as required. Resident #90 was admitted with diagnoses including atrial fibrillation and hypertension and had active physician orders for apixaban 5 mg twice daily, metoprolol ER 25 mg with hold parameters based on blood pressure and heart rate, and diltiazem ER 300 mg with hold parameters based on blood pressure. During an observation, a clear resealable plastic bag containing three brown medication bottles labeled as apixaban 5 mg, metoprolol ER 25 mg, and diltiazem ER 300 mg, along with a single foil package of dextromethorphan/guaifenesin 600 mg, was found left unattended on the sink counter in the resident's room in clear view. Review of the resident's active physician orders showed no active order for dextromethorphan/guaifenesin 600 mg. Resident #90 stated that a family member had brought the medications in the bag to the facility to help nurses identify what she had been taking prior to admission and that she only took medications given by the nurses and did not wish to self-administer medications. Nurse #1, who was assigned to administer this resident's medications that day, reported having been in the room earlier but did not notice the bag of medications. Nurse #1 stated that medications should be stored in the medication cart for safety and confirmed she removed the bag after being informed by the surveyor. The DON and the Administrator both stated that medications should not be left in a resident's room and should be stored in the medication cart, and it was clarified to the Administrator that the nurse became aware of the unsecured medications only when notified by the surveyor.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.