Improper medication storage and labeling were found in two medication carts. Unopened-date inhalers, eye drops, and PPD were left without open dates, PPD was stored in the cart instead of the refrigerator, an unlabeled medication cup contained softgel tablets, and loose pills were found in cart drawers. RNs and the DON acknowledged that medications should be dated when opened and that unlabeled or loose medications should not be left in the carts.
Improper medication and supply storage was found in medication carts and a medication storage room. Surveyors observed an opened but undated bottle of Thera Tears, loose single-dose medications and injectable vials in cart drawers, an opened Hydrofera Blue dressing package, unlabeled medication cups with unknown tablets, and multiple expired blood collection tubes, syringes, and needles. Staff, including the DON, IP, clinical resource nurse, NHA, and an LPN, acknowledged the items had been missed during recent reviews.
Unlabeled Medications Found in Medication Carts: Multiple medications and biologicals in two medication carts were stored in labeled boxes, but the individual inhalers, eye drops, artificial saliva spray, morphine oral solution, and insulin vial were not labeled with the resident's name or the date opened. RN and LPN staff stated medications should be labeled inside their boxes because the box could be damaged or the medication could become separated, and an unlabeled medication could lead to a medication error.
Expired and discontinued medications were found in two medication carts, including a discontinued methocarbamol order left in a resident’s drawer and an expired guaifenesin tablet on another cart. An LPN said discontinued medications should be removed from the cart and discarded, and the DON stated unit managers were responsible for keeping carts free of expired and discontinued meds.
Loose medications were found at the bottom of a medication cart drawer, including fluoxetine, losartan, methocarbamol, potassium chloride, and a multivitamin. An LPN said a loose pill could be mistaken for the wrong medication and lead to a medication error, and the DON stated that nurses were responsible for keeping the cart clean during the shift and retrieving any pill that popped into the drawer.
Medication carts and storage rooms contained multiple labeling and storage errors, including an opened nitroglycerin bottle without a resident name, an undated Wixela inhaler, undated insulin glargine pens, and tuberculin vials without open dates. Staff also found expired or improperly stored items, including docusate past its expiration date, lidocaine patches for a discharged resident, and other items left in carts despite being personal items or having storage instructions that were not followed.
Improper medication storage and labeling were found in the medication room and on multiple med carts. Surveyors observed opened eye drops, insulin, TB serum, and nebulizer meds that were not dated, along with expired meds and supplies such as Flucelvax, suppositories, blood collection items, naloxone, lidocaine patches, and miconazole cream. Staff stated night shift nurses were responsible for routine checks of the med room and carts for expired items.
Improper labeling of medications in medication carts. Surveyors found multiple inhalers, eye drops, oral meds, and morphine stored in labeled medication boxes but not labeled on the individual containers with the resident’s name and/or the date opened. An LPN, RN, ADON, and DON all acknowledged that meds should be labeled inside the boxes because the containers could be separated or mixed up, which could lead to a medication error.
Improper Medication Storage and Labeling: Surveyors found expired Vitamin B12 in a med storage room, an open Lantus insulin vial without an open date in a med cart, an expired bottle of resident vitamins, and Lumigan eye drops with two different open dates on the box and bottle. An LPN confirmed the insulin had been used after opening without documenting the date, and the DON said the duplicate dates were not appropriate.
Surveyors identified a deficiency when expired OTC medications, including CoQ10, calcium, and acetaminophen, were found on a medication cart, despite facility policy requiring house stock medications to be stored in original containers with visible expiration dates and discarded when expired. An RN reported being trained to date OTC bottles when opened and discard them three months later, while an LPN demonstrated uncertainty about whether to follow a post-opening timeframe or the manufacturer’s expiration date and did not know where to find the facility’s policy. The DON stated staff were expected to follow manufacturer expiration dates, acknowledged that nurses were informally trained by other bedside staff, and confirmed there was no specific facility training on medication expiration dates, while also stating that expired medications should not be administered because they could make a resident very sick.
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