Improper Medication Storage and Unapproved Bedside Self-Administration
Penalty
Summary
The deficiency involves the facility’s failure to ensure that drugs and biologicals were labeled and stored in accordance with professional standards and facility policy, including requirements for self-administration and bedside storage. Multiple residents were observed with medications at their bedside without corresponding physician orders, self-administration evaluations, or documentation permitting them to keep medications in their rooms. Facility policies required medications to be stored in locked areas, prohibited leaving medications at the bedside, and mandated a self-administration evaluation and specific provider orders before residents could self-administer and store medications in their rooms. Several residents were found with medications at their bedside that lacked appropriate orders or evaluations. One resident with atrial fibrillation, hypertension, and aphasia had saline nasal spray on the bedside table on two separate observations, with no documented physician order or self-administration evaluation. Another resident with fractures and osteoporosis had a calcium carbonate chewable tablet left in a medication cup at the bedside; the resident reported staff left it there because they preferred to take it slowly, but there was no order or evaluation for self-administration. A resident with dementia and cataracts had Refresh Tears eye drops and antifungal powder at the bedside on separate observations, with no documented orders or self-administration evaluation. Additional residents, including those with urinary retention, COPD, CHF, atrial fibrillation, sleep apnea, chronic pain, and GERD, were observed with saline nasal sprays, Flonase, Tums, antifungal powder, Icy Hot spray, and Refresh Tears at the bedside. In several of these cases, there were either no physician orders for the specific medications, no orders authorizing self-administration or bedside storage, or no documented evaluations supporting self-administration, despite some residents having prior self-administration safety screens for certain medications only. The facility also failed to store insulin pens and bulk medications in accordance with professional standards. On one unit, Lantus insulin pens for multiple residents were found loose together in the top drawer of both the south and north side medication carts; although the pens and caps were labeled, they were not stored in individual bags, allowing them to touch each other and creating an opportunity for cross-contamination. LPNs interviewed acknowledged that they knew pens needed to be labeled but were unaware they needed to be stored separately so they were not touching. On another unit, two medication cups labeled “Tylenol” and “Senna” in black ink were found in the top drawer of a medication cart, each containing multiple loose tablets. The assigned LPN confirmed the contents but denied placing them there and then discarded the medications. Staff interviews, including with LPNs, an RN, and the DON, confirmed that residents were supposed to have physician orders and competency evaluations to keep medications at the bedside, that medications should be secured and not left loose on bedside tables, and that certain items like nasal sprays and antifungal powders required orders and proper storage, which was not consistently followed in these instances.
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