Improper Dating and Storage of Multi-Dose Medications on Medication Carts
Penalty
Summary
The deficiency involves the facility’s failure to ensure that multi-dose medications were properly dated upon opening and that expired medications were discarded, as required by manufacturer instructions. During an inspection of one medication cart in the presence of a medication aide, surveyors observed multiple multi-dose ophthalmic solutions and several insulin dial-a-dose pens without any documented open dates. These included neo-polymyxin B, tobramycin, and latanoprost eye drops, as well as various types of insulin pens, all of which have specific discard timeframes after opening according to the manufacturers’ directions. The lack of open dates meant compliance with these discard timeframes could not be verified. On a second medication cart inspected with another medication aide, surveyors found a multi-dose bottle of timolol eye drops with no open date, again contrary to manufacturer requirements that it be discarded a set number of days after opening. In addition, this cart contained multiple clearly expired multi-dose medications that remained available for use. These included an insulin glargine pen, two insulin lispro pens, neo-polymyxin eye drops, tobramycin eye drops, and several latanoprost eye drop bottles, all of which had open dates indicating they were beyond the manufacturer-specified discard periods. Interviews with the medication aides and the Assistant Director of Nursing (ADON) further clarified the circumstances leading to the deficiency. One medication aide acknowledged that all multi-use medications should be dated upon opening and stated she normally checked eye drop dates but had not done so that day, and she did not handle insulin, which she said was the nurse’s responsibility. The second medication aide stated she did not realize the eye drops were expired or undated and explained that time pressures contributed to her oversight. The ADON stated that both medication aides and nurses were expected to write open and expiration dates on multi-dose insulin vials/pens and open dates on eye drops, and she was unaware that staff were not consistently labeling medications as required. One latanoprost bottle was found with two different dates written on it, and the medication aide explained she had added a new date that morning after being told everything in the cart should have a date, indicating inconsistent and inaccurate dating practices.
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