Improper Storage of Controlled Medication in Refrigerator: An LPN observed 44 Lorazepam syringes for a resident stored on the center shelf of a medication refrigerator instead of in the locked controlled-substance box. The LPN stated the syringes would not fit in the locked drawer, and the DON confirmed they were not secured there even though they should have been. The resident had Anxiety Disorder and severe cognitive impairment with a BIMS score of 00.
Controlled substances were not stored as required when two of four medication carts contained removable narcotic storage boxes instead of permanently affixed compartments. An LPN on each wing confirmed the boxes could be removed, and the DON also verified the carts were not affixed. The pharmacist, Administrator, and an RN stated they were unaware the storage boxes were not permanently affixed.
Unlocked Medication Cart Left Unattended: Surveyors observed one of eight medication carts unlocked and unattended while an LPN was away from it. Facility policy required all drugs and biologicals to be stored in locked compartments, and the LPN confirmed he left his cart unlocked. He stated that leaving the cart unlocked and unattended could allow resident access to medications that could cause harm.
Medication was left unattended at the bedside for one resident, and a prescription bottle of Nystatin powder belonging to another resident was found at a different resident’s bedside. An LPN acknowledged leaving oral meds at the bedside despite knowing they should not be left unattended, and the DON confirmed the expectation was to observe the resident swallow the meds. The bedside Nystatin bottle was not from the facility pharmacy and there was no active order for it.
Medication Label Did Not Match EMAR Order: An LPN administered a pharmacy-prepared Benztropine pack labeled 0.5 mg even though the EMAR order listed Benztropine Mesylate 1 mg with directions to give 0.5 mg twice daily. The LPN acknowledged the mismatch, and the DON confirmed the order and label did not correspond for a resident with schizophrenia, major depressive disorder, and moderate cognitive impairment.
Improper labeling of opened multi-dose medication vials was found on two medication carts. An LPN and the ADON identified that several opened multi-dose vials, including insulin and ophthalmic solutions, were missing open dates or had dates that did not align with the facility policy for dating and discarding after opening. Residents affected had active orders for the medications observed, including eye drops and insulin.
An LPN observed that insulin pens on a medication cart for two residents were in use but not dated when opened. Facility policy and in-service materials stated insulin should be dated when opened and discarded after 28 days. The LPN stated undated insulin could not be verified as safe to administer, and the DON stated nursing staff should ensure insulin on medication carts is labeled with an open date.
Unsecured medications and treatment solutions were found accessible in a resident room, including multiple bottles of Dakin's solution, ethyl alcohol, and hydrogen peroxide left on a table, in a pail, and on a counter. Surveyors also observed an unlocked, unattended med cart; an LPN acknowledged leaving it unsecured, and the DON stated carts should remain locked unless actively in use.
Surveyors found that staff failed to properly secure and store medications for two residents. For one resident, an LPN received a delivery of Hydrocodone-Acetaminophen, passed it to another LPN, and the controlled medication was left unattended at the nurses’ station instead of being immediately locked and entered into the narcotic count, after which it could not be located. For another resident, two bottles of Lorazepam oral concentrate, documented on the narcotic record and labeled to be protected from light and refrigerated, were observed stored in a locked medication cart rather than in the designated medication refrigerator, even though staff acknowledged knowing the manufacturer’s refrigeration requirement.
Improper Storage and Dating of Insulin on Medication Cart: An LPN observed several open insulin products on a medication cart that were either undated or beyond the manufacturer’s 28-day room-temperature limit, including Novolog, Humalog, Insulin Aspart, and a Humalog KwikPen for multiple residents. The facility policy required storage per manufacturer specifications, and the LPN stated undated insulin could not be verified as safe to administer; the DON confirmed insulin on carts should be labeled with an open date and kept within the 28-day use period.
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