Medication storage and monitoring were deficient when insulin pens and vials were found without proper opened dates, with one resident’s insulin label illegible and other insulin items dated 44 days earlier. The medication room refrigerator log also had missing daily temperature entries for multiple days, and staff confirmed the missing documentation and that the responsible nurse had been away during that period.
Insulin for three residents was found without an open date on the med cart during a tour. An LPN verified that insulin should be dated when opened, and an administrative nurse later confirmed the same. The facility policy stated that outdated or deteriorated drugs and biologicals must not be used.
Expired medications were found in an emergency kit stored in the med room, including multiple antibiotics, epinephrine, naloxone, warfarin, potassium chloride, clonidine, lisinopril, furosemide, phytonadione, prednisone, and fluconazole. An ADON verified the expired stock and stated the pharmacy was responsible for periodic checks and removal of expired meds, but was unsure when the kit had last been inventoried.
Expired medications and vaccines were found stored in the medication room refrigerator, including IM lorazepam, high-dose influenza vaccine, and influenza vaccine. An LN said nurses were supposed to periodically check for outdated meds, while an Administrative Nurse said the pharmacy consultant removed outdated meds quarterly and that overnight staff checked the refrigerator during temperature checks. The facility could not provide a medication storage policy.
Unlabeled insulin flex pens were found for several residents, including a resident’s Novolog pen and another resident’s Humalog pen, along with multiple Lantus and Humalog pens on treatment carts. Nurses verified that insulin pens should be dated when opened and marked with the discard date, but the pens observed were missing the correct open and discard dates or had inaccurate dates.
Opened insulin pen was not dated. An LPN preparing a resident’s Novolog insulin found the pen lacked the required open date, and the DON later confirmed it should have been dated. Facility policy required opened multi-dose insulin to be dated and discarded within 28 days unless the manufacturer specifies otherwise.
Expired Famotidine 10 mg was found on the 300 and 400 Hall med cart during observation. A CMA verified the medication was expired, and an Administrative Nurse stated that med aides or nurses were responsible for checking the cart and discarding expired meds. The facility policy required outdated medications to be immediately removed from stock and disposed of according to procedure.
Medication storage was not secured when the keys to a med cart were left in a narcotic count binder and an unlocked treatment cart contained prescription creams and dressings. An LN stated the keys had been left there because two LNs were on the cart, and an Administrative Nurse stated cart keys were expected to stay on the nurse or CMA and carts were to remain locked.
Unattended unlocked treatment cart with resident medications. An LPN left a treatment/med cart unlocked and unattended while entering a resident room, with the cart containing nebulized txs, topical meds, dressing supplies, and multiple insulin pens for several residents. The LPN stated the cart should never have been left unlocked and unattended, and the ADON stated the cart should be locked whenever staff walked away and resident information should not be visible to unauthorized persons.
A facility failed to label one resident’s Humalog FlexPen with an open date and expiration date when first used and failed to discard another resident’s expired Lantus FlexPen. During treatment cart observation, one insulin pen had no date labels and the other had already passed its expiration date, despite the facility policy requiring dates to be recorded and expired meds to be removed.
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