An unlocked medication cart was observed unattended with the narcotic book open, and staff confirmed the cart should have been locked when not in use. In a separate observation, a resident’s prescription chlorhexidine mouthwash was found on the bedside table even though there was no visible lock box or locked drawer, and staff gave conflicting information about bedside medication storage.
Expired and contaminated medications were found stored with current stock in 2 medication carts and 1 medication room. Surveyors observed an expired Povidone-Iodine prep pad, an antiseptic spray with black floating substance, another expired antiseptic spray in a second cart, and expired children's acetaminophen floor stock in the medication room. An LPN confirmed the expired and contaminated items, and the DON stated there should be no expired medications in carts or medication rooms.
Unlocked medication carts, expired supplies, and an unlabeled insulin vial were found during observations. A medication cart and a treatment cart were left unlocked and unattended while an RN stepped away, expired wound care supplies and Povidone-Iodine were found on a treatment cart, and an opened vial of insulin lacked an open date and discard date. An LPN confirmed opened medications should be dated.
A facility failed to keep medications securely stored when an LPN left prepared doses unattended on a locked med cart and when eye drops were placed on a resident’s bedside table. Two residents’ oral meds were found in cups on the cart, and a resident with intact cognition reported self-administering timolol eye drops after staff left them in the room.
Medication storage and labeling were deficient in multiple areas of the LTC facility. In two medication carts and one medication room, several opened meds and biologicals, including inhalers, insulin products, and Tubersol, were found without open dates, while one expired Vitamin B12 supply was also observed. In addition, a medication room was left unsecured and confirmed by an RN.
A resident's omeprazole dose was left in an unmarked cup on top of an unattended med cart while the RN assisted another resident. The RN later returned the opened medication to the cart and administered it later, despite the UM, IP, and DON stating opened medication should not be put back in the cart and should be discarded.
Unlocked Medication Storage Areas and Treatment Carts: Surveyors observed the B-wing medication room unlocked and treatment carts on A and B Wing unlocked with keys left in the locks and no staff present. Facility policies required medication rooms, carts, and medication supplies to remain locked when not attended, and an LPN stated the room should have been locked but another nurse must have forgotten. The DON stated medication storage areas are required to remain locked and noted the facility had previous issues with medication storage.
Expired and unlabeled medications were found in multiple medication carts and a medication room, including an expired Buspirone card, inhalers without prescription or open-date labels, open Artificial Tears and Anero Ellipta, expired glucose control solutions, and expired blood glucose test strips. An Albuterol inhaler was also found with the meter reading 0 puffs. The UM and DON stated carts and medication rooms were being audited by nursing and pharmacy staff on a weekly and monthly basis.
Expired house stock medications were found in a medication cart available for resident use, including naproxen and Orajel toothache rinse past the manufacturer expiration date. An LPN confirmed both items were expired, while staff stated medication carts were audited weekly and expired meds were supposed to be destroyed. The UM said she placed the naproxen in the cart without checking the expiration date, and the ADM and DON stated expired meds should not have been in the cart.
Medication Labeling Errors in Refrigerator: An opened tuberculin PPD vial and an opened semaglutide injection pen were observed without required opened or discard dates, and another PPD vial had an expired discard date. Facility policy required multi-use vials and other medications to be labeled with applicable dates, and the DON, Corporate Clinical Consultant, and IP all confirmed that opened medications should have opened and expiration/discard dates.
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