Unsecured Medications, Inadequate Self-Administration Assessment, and Unlocked Carts
Penalty
Summary
The deficiency involves the facility’s failure to ensure medications and biologicals were properly labeled, stored, and controlled, and that residents were not in possession of medications at bedside without appropriate assessment and physician orders. One resident with diagnoses including a right artificial hip joint, atrial fibrillation, hypertension, encephalopathy, urinary tract infection, hypertensive heart disease, and a BIMS score of 11 indicating moderate cognitive impairment was observed to have Equate nasal spray and a dermal wound cleanser on the bedside table. Review of the physician’s orders showed an order only for Fluticasone Furoate nasal suspension as needed for allergies, with no orders for Equate nasal spray or the dermal wound cleanser, and no orders for self-administration of medications. The electronic health record contained no assessment for self-administration, and the care plan documented impaired cognitive function/dementia and interventions stating that medications were to be administered as ordered and monitored for side effects and effectiveness. Staff interviews confirmed that the items at bedside were considered medications and should not have been left with the resident without appropriate assessment and orders. A CNA stated that medications, including nasal spray, should not be at the bedside and acknowledged the risk of inappropriate use. An LPN stated that both the nasal spray and dermal wound cleanser were medications and should not be at bedside, and further explained that residents must be assessed for the ability to self-administer medications, with an order put in place and reassessments every six months or sooner with a change in condition. The ADON similarly stated that medications are to be administered as ordered and that a resident would need to be assessed to self-administer medications, noting that medications at bedside without an assessment could result in inaccurate dosing, use outside the intended purpose, or access by others. Additional deficiencies were identified related to unsecured medication and treatment carts. A treatment cart was observed unlocked and facing away from the nurse’s station while staff, residents, and visitors walked past; an LPN confirmed it was a treatment cart containing prescription treatments and acknowledged it was supposed to be locked. The ADON reported that there are multiple medication and treatment carts, with access controlled by keys or codes, and stated that residents could get into the cart and the medications in it. On another occasion, a nurse left a medication cart unsecured while walking away from it into a room, leaving a resident in a wheelchair behind the cart; the LPN involved acknowledged the cart was left unsecured and stated that the risk of not securing the cart is that someone could grab something. Facility policies on storage and administration of medications require that compartments containing drugs and biologicals, including carts, be locked when not in use and not left unattended, and that residents may self-administer medications only if the physician and interdisciplinary team determine they have the decision-making capacity to do so safely.
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