Surveyors found multiple expired medications, including various insulin products, Trulicity injection pens, and a large bottle of Gabapentin solution, stored in a medication room refrigerator and still available for use. The MDS coordinator confirmed the drugs were expired. The DON reported that no one had been specifically assigned to check the refrigerator for expired medications, while an LPN stated she only reviewed medication carts and did not check refrigerated stock. Facility policies required checking expiration/beyond-use dates before administration, dating multi-dose containers when opened, discarding them within specified time frames, and returning or destroying outdated medications, but these procedures were not followed for the medications in the refrigerator.
A medication storage deficiency occurred when a medication cart on one nursing unit was left unlocked and unattended. An LPN believed the cart’s timer-based lock had engaged when stepping away, but when attempting to demonstrate that it was locked, a drawer opened, confirming it was unsecured. The LPN reported not knowing the exact timing of the cart’s automatic lock and acknowledged not double-checking its status. The CRN later stated that medication carts are required to be locked whenever staff leave them unattended.
Surveyors identified multiple failures in medication storage and control, including unsecured bedside medications and improperly stored controlled drugs. One resident with a history of blood clots and depression had zinc oxide and antifungal cream left at the bedside without an IDT self-administration assessment or a physician order to keep medications at the bedside. Another resident with CHF and diabetes had Biofreeze cream at the bedside, which staff applied, but there was no provider order or care plan for its use, and the ADON reported the family likely supplied it. Additionally, Lorazepam nasal spray, a Schedule IV controlled medication, was found in clear plastic cups on a medication refrigerator shelf instead of in a separately locked, permanently affixed compartment, and a medication cart on one hall was observed left unattended, unlocked, with a drawer open.
Surveyors found a medication cart unlocked and unattended in a resident care hallway, despite facility policy requiring medications to be stored safely, securely, and accessible only to authorized personnel. An LPN later confirmed she had left the cart unlocked and acknowledged it should have been locked, creating a situation in which medications could be accessed by individuals for whom they were not prescribed.
Surveyors identified multiple failures in medication labeling, dating, and storage, including an illegible lorazepam label in the refrigerator, an opened tuberculin vial and a Hepatitis B vaccine syringe improperly stored, and a non–permanently affixed locked box containing insulin and narcotics in the medication refrigerator. In a medication cart, loose unlabeled pills and various identified tablets were found in drawers, and a bottle of glucose test strips in use lacked an open date despite manufacturer instructions. An unattended medication cart was also observed with a pill on the floor nearby, which an LPN later admitted she had dropped and not properly located and destroyed.
The facility failed to ensure medications were securely stored and free of expiration. A resident with dysphagia and a gastrostomy, who required assistance to store medications securely, was observed with medication cups containing white powder residue and multiple Jevity containers on the bedside nightstand. The resident reported that nurses sometimes left medications on the nightstand and that he occasionally obtained his own medications from the hallway and kept them there until use, without being instructed to store them elsewhere. Additionally, surveyors found multiple expired Bacitracin ointment packets in a medication cart drawer; an LPN confirmed they were expired, and the DON acknowledged there was no set schedule for checking carts for expired medications, relying instead on nurses to notice during med pass.
Surveyors found that medications and treatment supplies on two medication carts and one treatment cart were not properly labeled, dated, or secured. On one cart, eye drops had illegible labels with old open dates and glucose test strips lacked an open date, while staff stated these items should only be used for 30 days after opening. A treatment cart containing medicated creams was observed unlocked in a hallway, and another cart contained undated glucose test strips, with an RN acknowledging they should have been dated and being unsure of their post-opening usability period.
Surveyors found that medication refrigerators used to store narcotics, vaccines, and insulins were not consistently monitored and documented per facility policy, with numerous missing temperature entries on both AM and PM shifts across multiple months in two medication rooms. An RN, an RCM, and an SDC acknowledged the incomplete logs, and the facility policy required at least daily monitoring for medications and twice-daily monitoring for vaccines, creating the potential for residents to receive medications and vaccines stored outside recommended temperature ranges.
Surveyors found that glucose control solutions used for blood glucose testing were not dated when opened, despite manufacturer instructions and facility policy requiring documentation of an open date and three-month discard date. Review of blood glucose logs showed the same undated solutions were used over several months, and staff acknowledged they should have been dated and limited to three months of use. In addition, a medication cart on one hall was observed left unlocked and unattended, contrary to facility policy requiring carts to be locked when out of sight, and both an RN and the DON confirmed the cart should not have been left unlocked.
Surveyors found that the facility failed to remove expired medications from the medication storage room. During an inspection of the medication room refrigerator with the ADON, five acetaminophen suppositories with a past expiration date were discovered still stored and available for use. The ADON confirmed the suppositories were expired and should not have remained in the refrigerator, creating the potential for adverse effects if administered.
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