Failure to Discard Expired Medications and Date Open Multi-Dose Drugs
Penalty
Summary
The deficiency involves failure to ensure medications were properly dated upon opening and expired medications were discarded from medication carts and the medication room. During observation of the medication room refrigerator with the DON and a nurse, surveyors found an open, undated vial of Apilsol Tuberculin PPD solution, despite manufacturer instructions that it be discarded within 30 days of opening. On one medication cart, surveyors identified an expired bottle of nitroglycerin 0.4 mg tablets and multiple insulin pens (Humalog, Insulin Glargine, and Basaglar) that were either opened and undated or opened and dated beyond the manufacturer’s 28‑day use period. On another medication cart, surveyors observed a used, undated Novolin R FlexPen and a bottle of 200 mg ibuprofen tablets past the manufacturer’s expiration date. Nursing staff interviewed stated that the nurse who opened a medication was responsible for dating it and that night shift nurses were responsible for routinely checking medication carts and the medication room for expired medications. Staff also described monitoring of medications as a team effort and acknowledged they had not yet checked their carts on the day of observation, despite the DON’s stated expectation that nurses date medications upon opening and discard expired medications as needed.
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