Discontinued Schedule II through V controlled substances were stored in a locked file cabinet inside the DON office, but the cabinet was not permanently affixed and the office door was used as the second lock. During observation, the DON office was open and unattended, allowing access from the adjacent hallway. Fourteen discontinued controlled substance prescriptions in bubble packs and bottles were found in the cabinet, including hydromorphone, oxycodone, Lyrica, tramadol, alprazolam, lorazepam, pregabalin, morphine sulfate, and hydromorphone oral solution.
Controlled substances were not properly secured or reconciled after a resident with severe dementia and hospice status expired. An ADNS and an LPN removed the resident’s Lorazepam and other controlled meds from the cart, but the meds were placed in a plastic bag, stored in a locked file cabinet that was not a proper double-locked controlled substance cabinet, and not reconciled with the DNS for several days. A later audit found a Lorazepam discrepancy, with one reconciliation sheet and one bottle unaccounted for.
Expired controlled meds remained in emergency stock and were administered to residents after the labeled expiration date. Staff counted the narcotics at shift change but did not verify expiration dates, and expired hydrocodone/APAP and alprazolam were found in stock. The expired alprazolam was given 15 times to four residents, while the RN, DON, and pharmacist each described shared responsibility for removing expired meds.
Controlled medications were not stored in separately locked, permanently affixed compartments in the med refrigerator. An LPN, the ADNS, and the DON all confirmed that the North Side and South Side controlled substance boxes were locked but not permanently affixed, and the boxes contained unopened lorazepam vials. The DON stated the boxes had been replaced after the keys broke and she assumed they were affixed, while facility policy required Schedule II-V meds to be stored in separately locked, permanently affixed compartments.
Expired supplies were found in both medication rooms, including syringes, tests, suppositories, Linzess, emergency box items, atropine sulfate, and clarithromycin, despite a signed overnight checklist indicating expiration checks were completed. In a separate observation, an RN left a medication cart unlocked in the hallway with the top drawer open while administering meds to a resident, and both the RN and Nursing Supervisor stated the cart should have been secured.
Expired medications were found in a medication cart and a medication storage room. Surveyors observed Narcan and Milk of Magnesia on a cart, along with Bisacodyl, geri-dryl, and stool softener in a medication room, all past their expiration dates or due to expire based on month-and-year labeling. An LPN, RN, and the Regional Clinical Director stated expired meds should be removed from circulation and discarded by the expiration date, with month-and-year items discarded on the first day of that month.
Expired medication was found stored in a Level 1 med room when 2 boxes of Mucus Relief ER were observed past expiration. An LPN said nurses and the person stocking meds check for expired items, and the DNS stated expired medication should not be stored in the med room. The consultant pharmacy summary also noted isolated issues with expired meds removed from carts on Unit 2.
A resident’s meds were left in a cup on the bedside tray table after an LPN was called out of the room before seeing the resident take them, and the resident said he/she was unaware the meds had been left there. In a separate observation, a medication cart was found unlocked and unattended in a hallway, contrary to facility policy requiring meds and controlled substances to be stored securely and carts to remain locked when not in use.
Improper storage and labeling of IV supplies were observed in multiple medication rooms and in a resident’s room. A resident receiving IV meds had pharmacy-labeled normal saline flushes hanging from the IV pole in the room, while other saline syringes were stored as house stock in medication room drawers, and additional IV meds and unlabeled IV tubing and caps were found in a first-floor medication room. Staff stated resident supplies were being placed together and used for other residents, and saline flushes were also used for wound care.
Expired heparin lock flushes and expired 0.45% NS IV hydration bags were found stored in medication storage areas. An RN stated there should be no expired IV supplies in the rooms and that she did not check for IV meds and supplies, while the DNS stated nursing was responsible for ensuring expired medications were removed. The facility policy required all expired medications to be removed from active supply and destroyed.
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