Expired medications were found on two medication carts, with an LPN confirming outdated clonidine, morphine sulfate, duloxetine, and hyoscyamine sulfate remained stored on the carts. The facility policy stated expired medications should not be available for use and should be removed from medication carts at or before expiration. Residents involved had diagnoses including HTN, kidney disease, dementia, Alzheimer’s disease, CHF, diabetes, depression, GERD, and osteoarthritis.
Medication cart security was not maintained for Cart 700. Facility policy required the cart to be locked when out of the medication nurse’s sight, but an RN walked away from the cart and later entered a resident room while leaving it unlocked and unattended. The RN confirmed the cart should have been locked, and the President of Clinical Operations confirmed carts should be locked when unattended.
Unsecured and unlabeled medications were found at a resident’s bedside and in a medication cart. A resident with multiple diagnoses, including HTN and delusional disorder, had several scheduled oral meds left unattended in a clear cup on the nightstand without a self-administration order or assessment, and an LPN identified the pills as the resident’s medications. In a separate observation, an LPN and the DON found prepared, unlabeled meds left in a med cart drawer instead of being administered or otherwise secured.
Unlocked Wound Treatment Cart Left Unattended: A wound treatment cart containing topical medications and supplies was observed unlocked and unattended on two occasions, once in the East hallway and again outside the nurse's station near the North Hall. The WCN said she had not been there since Friday, an LPN stated the cart is not to be unlocked, and the DON confirmed the cart was unlocked and its contents were accessible to unauthorized staff or visitors.
Unlocked medication and treatment carts were observed on the 100 hall, with drawers facing the hallway and no staff present. The RN/ADON confirmed the medication cart was unlocked and unattended, and the DON confirmed the treatment cart was also unlocked, unattended, and contained medications, contrary to facility policy requiring locked storage when not under direct observation.
Unattended Nebulizer Treatment and Improper Equipment Cleaning: A resident with COPD, HF, and anxiety received a DuoNeb treatment while holding the mouthpiece in his mouth with no nurse present, even though the DON stated he had not been assessed to self-administer meds. After the treatment, an LPN wiped the mouthpiece with a paper towel and placed it in a bag with the nebulizer cup still attached, rather than separating, rinsing, and air-drying the parts as required by policy.
Improper Medication Storage in Resident Rooms: Surveyors found a cognitively intact resident keeping oxymetazoline nasal spray, cough drops, barrier cream, and opened ear wax removal kits in the room, and another cognitively intact resident keeping antacid tablets at the bedside. Surveyors also found a lidocaine patch left in a bathroom from a prior resident. The IP and UM confirmed the items were not supposed to be left in those locations.
Expired sterile water vials, IV catheters, a syringe, hemorrhoidal suppositories, and blood collection tubes were found in medication storage, along with open sterile wound therapy foam kit packages available for resident use. An Insulin Lispro KwikPen was also stored in an unlabeled bag without the resident's name. An LPN and the DON confirmed the items were expired or not properly labeled.
Surveyors found unsecured medications in a medication room and in two residents’ rooms. In the med room, lorazepam vials were stored in an unlocked box in the refrigerator, and staff stated the box should be locked and secured. Two cognitively intact residents also had unsecured bedside medications: one had arthritis gel and another had wound cleanser, while the DON stated resident meds should be kept in the med cart and wound cleanser stored in a cabinet or drawer.
Expired and undated OTC medications were found available for resident use in a medication cart and the Central Supply room. Surveyors observed expired Prilosec OTC, an opened and undated bottle of Cetirizine, and several expired items including Iron tablets, Aspirin, Cholest Off Plus, and Acid reducer tablets. An LPN UM, the SC, and the ADON all confirmed the medications were expired or undated and had not been removed from inventory or discarded.
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