Medication storage and labeling were not maintained for two residents’ medications. An RN and KMA found eye drops without proper opened dates, an unopened insulin pen stored in a cart instead of the refrigerator, and two unopened vials of stock heparin kept in the same cart compartment as ophthalmic solutions. Staff and the contracted pharmacist confirmed that opened multi-use meds should be dated and that insulin and stock heparin had specific storage requirements.
Expired topical medications were found in the medication refrigerator for two residents. The products were labeled for use on a resident’s buttocks and for a stage 2 sacral wound, but both had passed their expiration dates. An LPN, the Unit 100 Manager, the DON, and the Administrator all stated expired medications should not be used and might be ineffective.
A resident admitted with acute osteomyelitis, renal abscess, and perinephric abscess had an active order for IV Meropenem when surveyors observed a full IV Meropenem bag hanging in the room with a discard date that had already passed. An LPN reported she had set up the antibiotic before discovering the PICC would not flush, did not notice the expired discard date, and left the bag on the IV pole. Facility policy addressed expiration and beyond-use dates but did not direct staff on handling medications past discard dates, while the DON and Administrator stated that nurses and unit managers were expected to check medication rooms and ensure expired medications were removed.
Improper storage of refrigerated medications, vaccines, and insulin was identified when the medication refrigerator was observed at 48 F, with ice buildup in the freezer and repeated temperature logs below the required 36 F to 46 F range. Fifty-eight Afluria vaccines were tightly packed in a drawer without space for air circulation, and a resident’s insulin was used after its opened and expiration dates. Staff interviews showed uncertainty about the proper temperature range and storage requirements.
Surveyors found that controlled drugs, including lorazepam oral concentrate and injectable vials, were stored in unlocked or improperly secured conditions in medication refrigerators. An LPN and unit managers reported that they believed the locked medication room and locked refrigerator provided adequate double-lock security and were unaware that refrigerated narcotics required a separate, affixed lock box. Observations showed narcotic lock boxes in the refrigerators were either absent or not permanently affixed, contrary to facility policy requiring controlled substances to be stored in separately locked, permanently affixed compartments.
Unattended medication carts were left unlocked on multiple occasions. An RN left one cart in a hallway near residents, an LPN left another cart unlocked while administering meds via G-tube, and another RN left a cart unlocked while stepping away to grab a pen. The facility policy required carts to be kept closed and locked when out of the nurse’s sight, and the DON and Administrator stated carts were expected to be locked when unattended.
Medication storage and controlled substance handling were deficient when the facility kept a resident’s oral Ativan in a medication cart drawer despite the carton labeling requiring refrigeration, and the medication storage room lacked a separately locked, permanently affixed compartment for controlled drugs. The DON stated the Ativan was kept on the cart because it did not require refrigeration, while an RN was unsure whether the liquid Ativan needed cold storage after opening; the Administrator stated medication should be refrigerated as specified on the storage instructions.
Expired and undated eye drops were found on multiple med carts, including Wisteria Unit carts 1 and 2 and Lakeview Unit cart 1. Surveyors observed several opened eye drops and an eye ointment for multiple residents that were not dated or were past the usual 28- to 30-day discard timeframe. Staff, including the KMA, Pharmacy Consultant, DON, and ADON, stated eye drops should be dated when opened and checked before administration.
Medication storage was not maintained properly when a resident’s povidone iodine wound care medication was found on the bedside table in the room instead of being locked in the treatment cart. Staff, including an RN, LPN, and the DON, stated the solution was a medication and should not have been left in the room. In addition, a medication cart had loose pills, pill debris, and trash in the drawers, and staff stated the cart was too tightly packed and should have been kept clean and organized.
Medication Storage and Labeling Failures: Multiple medication carts and a medication refrigerator contained loose pills, opened medications without dates, and an expired product. An LPN, KMAs, the UM, the SDC, the DON, and the Administrator all described expectations for dating opened items, discarding loose pills, and keeping carts clean, but surveyors still found undated budesonide, Tubersol, Spiriva, and ProHeal, along with loose tablets and expired Glutose gel.
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