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.
A facility failed to ensure medications were properly stored in 1 of 4 treatment carts. An opened container of Normal Saline 0.9% was found in a treatment cart with a facility date showing it had been opened several days earlier, even though the manufacturer labeled it as do not reuse and sterile in unopened package. An LPN inspected the container and stated it should have been discarded after use rather than returned to the cart.
Medication labeling and storage were not maintained according to policy. Surveyors found an opened and undated Tubersol vial in one storage area and multiple expired, opened without dates, or otherwise unlabeled medications in several medication carts, including eye drops, eye ointment, inhalers, and nasal sprays. An LPN, RN, and DON confirmed the findings, and the medications were removed from storage.
Improper storage of expired medications and biologicals was found in 2 medication rooms. Surveyors observed expired Augmentin bottles in active storage, an opened Aplisol vial that was not dated when opened despite manufacturer instructions to discard after 30 days, and expired fecal occult blood test kits on a shelf near the refrigerator. RN and LPN staff verified the expired items, and the DON stated the items should not have been left in active storage and that Aplisol should have been dated when opened.
Improper medication storage was identified when surveyors found loose pills in 3 of 3 med carts, along with a Ziploc bag of Pro-stat packets with liquid in the bottom of the bag. The facility policy stated medications are to be kept in their containers and compromised or deteriorated med packs are to be discarded upon discovery. An LPN confirmed the loose pills and removed them, and staff interviews showed differing practices for cart cleaning and that loose pills should be discarded when found.
Expired Aspirin was found in a medication cart with in-date medications in 1 of 4 carts reviewed. The facility policy assigned nursing staff responsibility for maintaining medication storage and preparation areas, and an LPN confirmed the expired bottle during observation and removed it from the cart.
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