Improper Storage of Discontinued and Expired Medications: A resident’s discontinued Risperidone remained in a box labeled extra medicines in the med room instead of being removed from active storage, and an expired hemorrhoidal ointment was also found stored on a shelf. The LVN and DON acknowledged the discontinued medication should not have been kept with usable meds, and the facility policy required expired or discontinued meds to be separated and later destroyed.
A resident had multiple medications left unattended at the bedside, including unlabeled oral meds, topical gels, Trulance, and a Repatha injection case, without authorization for bedside storage. The resident said staff knew the meds were kept there and that help was needed to apply the topical meds. Record review showed no documented IDT assessment for self-administration and no physician order for Repatha, while an LVN confirmed only Trulance had supervised self-administration orders and another LVN admitted leaving Tylenol and famotidine at the bedside.
Medication storage and labeling were not maintained as required in several med carts and a med refrigerator. Staff stored Med Pass with resident meds in a med refrigerator, left multiple insulin pens and a Lantus vial at room temperature without open dates, and kept opened budesonide inhalation solution pouches without dating them. An unopened box of Bengay cream was also found at a resident’s bedside despite staff stating meds and topicals should not be kept there.
Multidose treatment medications on a treatment cart were found without open dates for four residents, including nystatin-triamcinolone cream, Silver Silvadene cream, Santyl ointment, and Dakins solution. An RN and the RMN stated open dates should be written on multidose meds when opened so they can be discarded on time, and facility policy required the date to be placed on the container.
Surveyors found expired and improperly stored medications in a medication room and Medication Cart A. A resident’s nystatin was still present after it was no longer ordered, an opened insulin pen was kept in the refrigerator past its expiration date, expired culture swabs were present, and an opened levalbuterol box was expired. Oral medications and a supplement were also stored with bisacodyl suppositories instead of being separated by route, and staff verified the storage issues.
An opened foil pouch of budesonide for a resident was found in a medication cart without the date it was opened, contrary to the manufacturer’s instructions and the facility’s medication labeling policy. An LPN reviewed the pouch, noted the two-week use limit after opening, and said he would discard it because he did not know when it expired; the DON also acknowledged the pouch should have been dated when opened.
Medication Room A was observed left open with a trash can propping the door, and staff confirmed it should have remained locked. Internal and external meds were stored together on a lower shelf, including calcium carbonate, diclofenac sodium gel, budesonide/formoterol, mineral oil enema, and saline laxative enema. The Drug Destruction Log also showed multiple entries signed by only one nurse, with one undated entry lacking the required two nurse signatures.
Expired Lantus insulin was found stored in a med cart for a resident with DM and HTN. An LVN confirmed the pen had been opened and should only be used for 28 days, while an RN stated expired medication should not remain in the cart. The facility policy required opened multi-dose vials to be dated and discarded within 28 days unless the manufacturer specifies otherwise.
Medication Left at Resident Bedside After Administration: A resident with a BIMS score of 15 had a cup containing nine unidentified meds left on the overbed table after an LVN administered vitamins, BP med, and a stool softener. The LVN stated she was not supposed to leave meds at the bedside but did so in hopes the resident would take them later, and the DON confirmed this was not facility policy and was considered a med error.
A facility failed to remove discontinued medications from use when medications belonging to discharged residents were found stored with active residents' medications. An LN confirmed a vial of regular insulin in the medication room refrigerator belonged to a discharged resident, and another LN confirmed dexamethasone oral solution and ipratropium bromide-albuterol sulfate inhalation solution in a med cart also belonged to discharged residents. The DON stated these medications should have been removed, disposed of, or stored separately from medications assigned to active residents.
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