Medication refrigeration and storage lapses were identified when a treatment cart still contained insulin products for a discharged resident, and 2 medication refrigerators had missing or out-of-range temperature logs over multiple months. The cart review showed insulin Lispro, Novolin R, and Lantus remained available after discharge, and staff stated these meds should have been removed within a few days. Refrigerator logs for the unit showed repeated missed checks and frequent temperatures outside the required range, with the QIPM, Nurse Manager, and Maintenance Director confirming the issues.
A resident had a cup containing medication left unattended on the overbed table at the bedside. An RN stated he/she thought the resident had already taken the meds when asked about them, and the issue was later discussed with the DON.
A resident had an unknown white powder left in a medicine cup on the over-bed table, and an LPN confirmed the resident had an active Nystatin order but was giving the treatment to CNAs and documenting it as administered before it was actually provided. The facility also had repeated out-of-range temperatures in three medication refrigerators storing insulin and vaccines, with staff stating they would call maintenance and document the issue.
Improper Medication Refrigerator Storage and Temperature Monitoring: A dormitory-style medication refrigerator with ice buildup was observed storing Insulin Lantus, Ativan, and PPD, while the DON stated it would also be used for vaccines. CDC guidance stated dormitory-style refrigerators should not be used, and manufacturer instructions for Lantus required storage between 36 and 46 degrees F. Temperature logs showed missing entries and out-of-range temperatures over the reviewed months.
Expired blood collection tubes were found available for use on multiple units, including blue top, yellow top, and red tubes past their expiration dates. Surveyors also observed an unlocked, unattended treatment cart on the Windmere Unit containing resident meds and treatments such as Compound W, Nystatin, Diclofenac, hydrocortisone cream, ammonium lactate, and SaniCloth wipes while staff walked past it.
Improper Storage of Controlled Substances and Medications: Surveyors found lorazepam oral concentrate stored in unaffixed plastic boxes inside unlocked medication refrigerators on two units, and medication refrigerators on three units were dormitory-type units with ice buildup while also storing medications, including insulin. Staff confirmed the refrigerators were not locked and that any nurse or medication tech could access the medication rooms and remove the controlled medication.
Expired and undated medications were found in several medication carts, a medication room, and the Pixis machine. Observations with an RN, LPN, and CNA-M identified expired tablets, insulin pens without open dates, and other medications kept available for use despite manufacturer instructions for dating and disposal after opening.
Expired and undated meds were found in the A Wing and B Wing treatment carts during surveyor observation with the DON. The carts contained expired acetaminophen suppositories, open insulin glargine and insulin lispro vials without clear open dates or expiration dates, and open Lantus Solostar pens with conflicting or missing dating, and the DON was unable to determine the expiration dates for several of the insulin products.
Surveyors found an unattended med cart on a unit with a med cup containing red liquid (identified by a CNA-M as Robitussin prepared for a resident) and a cup holding used crushing sleeves with med residue on top of the cart, while a resident was nearby in the hallway. The CNA-M stated she had left the cart and acknowledged she should have secured the medication in a locked drawer. This situation did not follow the facility’s policy requiring all meds and biologicals to be stored in locked compartments and prohibiting unattended med carts when meds are potentially accessible.
Surveyors found that the facility failed to remove expired medications and biologicals from active stock in both a medication cart and the medication room. During an observation with an LPN, multiple opened and unopened products, including ibuprofen, aspirin, calcium carbonate, vitamin D, vitamin B complex, multivitamins, a Fleets enema, and bisacodyl suppositories, were noted with past expiration dates yet remained stored as available for use in the cart, medication room, and medication refrigerator. These findings were discussed with the DON.
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