Unsecured Nasal Spray Left at Bedside Contrary to Medication Storage Policy
Penalty
Summary
The deficiency involves the facility’s failure to ensure that medications and biologicals were stored in locked compartments in accordance with state and federal requirements. Surveyors observed that a prescribed Fluticasone Propionate nasal spray, ordered as 50 mcg/ACT, one spray in each nostril once daily for allergies, was left on the bedside tray table of a resident. The resident, an elderly female with COPD, acute respiratory failure, anxiety disorder, and myopathy, had a BIMS score of 9 indicating moderate cognitive impairment, though she was able to make herself understood and understand others. Her care plan identified potential for impaired cognitive function and thought processes related to oxygenation status and COPD. During observation, the resident was seated in a chair with oxygen in use and the nasal spray was visible on her bedside tray. The resident stated that staff normally kept the medication locked up and she did not know why it remained on her table. Review of the facility’s policies showed that medications and biologicals were to be stored safely and securely, accessible only to licensed nursing personnel, pharmacy personnel, or staff authorized to administer medications. The facility’s self-administration policy required an interdisciplinary assessment and specific conditions, including lockable bedside storage, before residents could keep medications at bedside; the policy also required staff to report any unauthorized bedside medications. Interviews with staff confirmed that the facility did not currently allow residents to self-administer medications and that residents were not supposed to have medications in their rooms. A CMA acknowledged that she had given the resident her nasal spray, left the room, and later realized she had left the medication in the resident’s room, stating she was responsible for returning it to the medication cart. Other CMAs, an LVN, the ADON, the DON, and the administrator all stated that medications should not be left in resident rooms, that no residents were authorized for self-administration at that time, and that the nurse or medication aide in charge of the medication cart was responsible for ensuring medications were properly stored. This sequence of actions and inactions led to the medication being left unsecured at the resident’s bedside in violation of facility policy and regulatory requirements.
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