Unattended, Unlocked Medication Cart and Unsecured Medications
Penalty
Summary
The deficiency involves failure to keep medications secured in locked compartments as required by facility policy and professional standards. On multiple occasions during a single morning medication pass, an LPN prepared medications for several identified residents and then walked away from the medication cart, leaving it unlocked and out of sight. At one point, the LPN also left prepared medication on top of the cart while the cart remained unlocked and unattended. These observations were made repeatedly over the course of the morning for different residents, indicating that the cart and medications were accessible when the nurse was not present. During an interview, the LPN acknowledged forgetting to lock the medication cart and stated they were not focused, further noting that whenever they walk away from the cart there should not be any medication on top of it because another resident or unlicensed person could take the medication or access the cart. The Assistant Director of Nursing confirmed that the medication cart should always remain locked when not in use and when the nurse is not present, and that failure to do so could allow another resident or unlicensed personnel to take medications that could potentially harm them. The facility’s written policies require controlled substances to be stored under double lock and all drug storage compartments, including carts, to be locked when not in use and not left unattended if open or otherwise available to others.
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