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.
Insulin was found on a medication cart without open dates or beyond the 28-day room temperature limit after opening. An LPN confirmed several insulin vials and pens were expired or not dated, and the DON acknowledged that staff were responsible for checking insulin and removing it after 28 days.
Unsecured Medications Left at Resident Bedside: An LPN left a medication cup with six pills unattended at a resident’s bedside during a med pass, and the resident said she wanted to eat first. The resident later received the meds after the LPN returned. The DON stated nurses should not leave meds at the bedside, and the facility policy required drugs and biologicals to be stored securely and accessible only to authorized staff.
An unlocked and unattended medication cart was observed on B Wing, despite facility policy requiring medication carts to remain locked and secure when not in use. An LPN stated she got busy and forgot to lock the cart before charting, and the DON stated medication carts should never be left unlocked when not in use.
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