A resident admitted with acute osteomyelitis, renal abscess, and perinephric abscess had an active order for IV Meropenem when surveyors observed a full IV Meropenem bag hanging in the room with a discard date that had already passed. An LPN reported she had set up the antibiotic before discovering the PICC would not flush, did not notice the expired discard date, and left the bag on the IV pole. Facility policy addressed expiration and beyond-use dates but did not direct staff on handling medications past discard dates, while the DON and Administrator stated that nurses and unit managers were expected to check medication rooms and ensure expired medications were removed.
Surveyors found that controlled drugs, including lorazepam oral concentrate and injectable vials, were stored in unlocked or improperly secured conditions in medication refrigerators. An LPN and unit managers reported that they believed the locked medication room and locked refrigerator provided adequate double-lock security and were unaware that refrigerated narcotics required a separate, affixed lock box. Observations showed narcotic lock boxes in the refrigerators were either absent or not permanently affixed, contrary to facility policy requiring controlled substances to be stored in separately locked, permanently affixed compartments.
Expired and undated eye drops were found on multiple med carts, including Wisteria Unit carts 1 and 2 and Lakeview Unit cart 1. Surveyors observed several opened eye drops and an eye ointment for multiple residents that were not dated or were past the usual 28- to 30-day discard timeframe. Staff, including the KMA, Pharmacy Consultant, DON, and ADON, stated eye drops should be dated when opened and checked before administration.
Medication Storage and Labeling Failures: Multiple medication carts and a medication refrigerator contained loose pills, opened medications without dates, and an expired product. An LPN, KMAs, the UM, the SDC, the DON, and the Administrator all described expectations for dating opened items, discarding loose pills, and keeping carts clean, but surveyors still found undated budesonide, Tubersol, Spiriva, and ProHeal, along with loose tablets and expired Glutose gel.
Medication Storage and Labeling Deficiency: The facility failed to ensure drugs and biologicals were properly labeled and stored on 1 of 4 med carts. On the East Unit Back Hall cart, surveyors found four insulin pens without opened or use-by dates, an opened Humulin 70/30 vial without a resident name or open date, and an opened bottle of UTI Stat past its expiration date. The RN, Unit Manager, DON, and Administrator all stated that opened insulin products should be dated and expired meds or supplements should be removed from the cart by the expiration date.
Medications labeled with a resident's name, a capped syringe, and a glucometer were left unattended on top of a locked medication cart with no staff present. An LPN admitted to leaving the items while attempting to administer medications on time, despite being aware that this violated facility policy. Interviews with nursing staff and leadership confirmed that this action was against policy and unsafe.
Surveyors found expired intravenous antibiotics in the medication refrigerator labeled for two residents with complex medical conditions. Staff interviews revealed inconsistent practices and unclear responsibilities for removing expired medications, and the facility's policy did not address expiration dates or discarding procedures.
Drugs and biologicals were not labeled according to professional standards, and medications, including controlled drugs, were not stored in locked or separately locked compartments as required.
An LPN administered an expired nutritional supplement to a resident after retrieving it from a refrigerator, not realizing it should have been discarded per manufacturer guidelines. The facility's policy lacked specific instructions for labeling or discarding nutritional supplements, and the resident had significant cognitive impairment and multiple medical diagnoses. The DON confirmed staff are expected to follow manufacturer recommendations for storage and disposal.
Staff failed to store drugs and biologicals in their original packaging, resulting in unidentified pills being left on a resident's bedside table and loose pills found in two medication carts. A resident with intact cognition was unable to identify pills left in her room, and staff interviews revealed inconsistent adherence to medication administration and disposal policies. Facility leadership confirmed expectations for proper medication handling, but observations showed these were not always met.
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