Expired insulin vials were found on two medication carts, including opened Novolog vials on the 200 Hall cart and an insulin vial on the 400 Hall cart. The facility policy required checking expiration dates and notifying the manager if expired, and the Administrator, DON, and ADON all stated that nurses were expected to check carts daily, remove expired meds, and reorder replacements.
Expired IV start kits and nasal swabs intended for resident use were found in a medication storage room. An LPN confirmed the expired dates, and the Regional Nurse stated there was no policy for medication storage and supplies. The DON said the room had been checked for medications but not supplies, and an LPN later reported receiving education on checking expiration dates and reordering supplies.
Expired Vitamin D bottles were found in a medication storage room, and an insulin pen and insulin vial on a medication cart were labeled with an open date but no expiration date. The UM could not explain why the expired medications remained in storage, and an LPN confirmed the insulin should have had both an open date and expiration date. The DON stated nursing staff were responsible for checking expiration dates and that insulin expires 28 days after opening.
An LPN was observed leaving an A-Hall med cart unsecured and unattended in a resident care area. The LPN confirmed the cart was unlocked and stated it should be locked immediately before walking away. The facility policy states meds and biologicals are to be stored safely and securely.
An unlocked medication cart was observed unattended in a hallway between resident rooms while an LPN was providing care to residents. The LPN later locked the cart and confirmed she had left it unlocked, and the DON stated that medication carts should always be locked when unattended.
Surveyors found that a treatment cart containing topical medications was left unlocked and unattended in a hall across from a resident’s room after wound care was completed by an LPN. The facility’s policy requires that medication carts and supplies be locked or attended and accessible only to licensed or otherwise authorized staff. During interviews, the LPN confirmed the cart had been left unlocked and unattended, the IP LPN confirmed the LPN’s report that the cart was left unlocked, and the Administrator stated that all medications, including topical medications, were expected to be locked when not in sight of authorized staff.
An unlocked treatment cart was observed in a resident-accessible area with the bottom drawer open, and an LPN confirmed it was unsecured while she could not see it. A separate medication cart had dirt-like substance in drawers and a loose, unlabeled packet of Zofran; the LPN was unsure who it belonged to. The facility policy and DHS interview confirmed medication carts were to remain locked when not in use and kept clean by nursing staff.
Medication carts and resident medications were left unsecured in the South Wing. One RN left two medication carts unlocked and unattended, and during a medication pass another RN placed a resident’s medications on top of the cart, locked the cart, and walked away to take the resident’s BP while the medications remained unsecured and visible in the mall area. The DON stated nurses were expected to lock the carts and secure medications when not in use.
In the main med storage room, a refrigerator used for resident meds and vaccine vials was found at 34 degrees Fahrenheit, below the facility’s stated range for refrigerated meds. The temp log had multiple missing entries over several days, and an LPN and the DON confirmed the refrigerator was supposed to be checked and documented at least daily but had not been monitored consistently.
Surveyors observed an unattended, unlocked medication cart with a medication bottle and a cup containing two loose pills left on top, with no nursing staff nearby, contrary to facility policy requiring medications to be under direct observation or locked during a med pass. An LPN reported leaving the medications on the cart while taking a resident to their room to check insulin, and both the DON and the Administrator confirmed that medications should not be left unattended and that once medications are removed, they are expected to be administered immediately.
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