Improper Storage of Expired and Unsecured Medications: Surveyors found opened Latanoprost eye drops stored in a resident’s room refrigerator without an order for self-administration, and additional opened Visine eye drops in a med cart drawer past the expected discard timeframe. The DON confirmed the resident did not have an order to keep meds at bedside or in the room refrigerator, and the facility policy required medications to be stored in locked, secured locations and outdated products to be removed.
A treatment/wound cart containing resident meds was observed unlocked in the resident care area with no nursing staff present. The cart held lidocaine cream, triamcinolone (TAC) cream, and nystatin powder. The RCM RN confirmed the cart should not have been left unlocked, and the DON stated staff were expected to lock the cart before walking away. The facility policy required drugs and biologicals to be stored in locked compartments.
Unlocked medication and treatment carts were observed unattended and accessible to unauthorized persons, including a medication cart at the 100 Hall entrance, another medication cart on the second floor, and a treatment cart containing wound care products and resident-specific meds. Nurses confirmed the carts were left unsecured, and the DON stated carts were expected to be locked when not in view. Expired meds, including hydroxyzine HCl and Allegra, were also found in a medication cart, and the DON stated expired meds should be removed from carts and stored pending destruction.
An unsecured medication cart was observed left unlocked and out of an RN’s sight, and the DON confirmed it should not be left unattended unlocked. Nine insulin pens for three residents with diabetes were stored together in the same cubby of a med cart without a barrier to prevent cross-contamination. Medication room and refrigerator temperature logs also had multiple missing entries, and the DON confirmed each shift was responsible for documenting those temperatures.
A resident with multiple diagnoses had several medications and topical products left on the overbed table without a medication self-administration assessment or MD order, and the DON confirmed staff should remove medications from the bedside when observed. In addition, an open multi-dose vial of Tuberculin Diluted Aplisol was found in the med refrigerator after the Unit Manager stated it should have been discarded within 30 days of opening.
Unsecured and Outdated Medications Found in Medication Carts: An RN left two medication bottles on top of a med cart while the cart was out of sight during med pass, and an inspection of a separate med cart found an outdated bottle of Diphenhydramine 25 mg tablets. The RN, LPN, and DON all confirmed the medications should have been secured in the cart and expired meds removed from stock.
A bottle of fluticasone propionate nasal spray was observed left unattended on top of a medication cart in a hallway while an RN was in a nearby resident room. The RN confirmed the medication had been left accessible, and the DON stated medication should not have been left out unattended. Facility policy required medications and biologicals to be stored in a controlled environment.
Improper Medication Storage and Refrigerator Monitoring: An LPN and ADON found a resident’s meds stored in the room despite no self-administration order, incomplete med refrigerator temp logs, an expired suppository in the fridge, an unlabeled unused insulin pen in a med cart, and multiple insulin pens plus a glucometer stored together without separation. A used insulin pen was also found lying on top of lancets, and staff confirmed the storage practices were not proper.
Medication Storage and Security Lapses: A RN left a lidocaine patch unattended on top of a med cart while taking a resident's meds to PT, and later confirmed it should have been locked in the cart. Surveyors also found lorazepam 2 mg/ml stored in a med cart drawer even though the manufacturer's label and facility medication guide directed refrigeration at 36-46 degrees F and protection from light.
Medication Storage and Labeling Deficiencies: Surveyors found an Arformoterol Tartrate medication that required refrigeration stored in an OTC cabinet at room temperature, an opened Lorazepam MDV without an opened date, and expired OTC eye drops and earwax softener in medication storage areas. The ADON confirmed the storage and labeling issues, and the DON stated night shift staff were expected to check medication rooms monthly and discard expired and discontinued meds.
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