Expired medications were found in the Main Medication Stock Room, including multiple bottles of Mylanta, Melatonin, Aspirin, multivitamins, and vitamin B12. An LPN confirmed the medications were expired and said they should not have been in stock, and the DON stated expired meds should not be in the medication rotation.
Improper Storage and Labeling of Medications: A surveyor observed a resident's liquid morphine on a unit E med cart with no open date label after it had been opened, and also found lorazepam stored in a refrigerator inside a locked cabinet with other medications rather than in a separately locked compartment. The RN was unsure about the storage requirement, and the ADON stated the controlled medication should have been locked separately.
Unlocked Medication Cart Left Unattended: Surveyors observed an LPN leaving a vent unit med cart unlocked and unattended during med pass, and the cart was also later observed unlocked and unattended in a public area. The facility policy required medication compartments to be locked when not in use, but 1 of 5 med carts was found unsecured, affecting medications for 10 residents.
Medication refrigerators in one med storage room were not maintained at the proper temperature. Surveyors observed a full-sized refrigerator and a compact refrigerator storing insulin and IV meds, with logs showing repeated temperatures below the required 36 to 46 degrees F range and thermometers reading 30 degrees F and 34 degrees F. The RNUM agreed the refrigerators were not at the correct temperatures, and the NHA and DON were informed.
A resident with dementia and other psychiatric diagnoses, who is rarely or never understood per MDS, was observed in a wheelchair with a nitroglycerin patch stuck to the wheelchair wheel, despite having no order for nitroglycerin. An RN confirmed the patch was dated from the prior day and stated that only one other resident on the unit had an order for such a patch, which should have been removed the previous night. Both the RN and the DON described the facility’s required process for nitroglycerin patch disposal—folding the patch in half and placing it in a sharps container or immediately removing it in trash—and acknowledged that the patch found on the wheelchair wheel was not disposed of according to facility policy or accepted professional principles.
Two residents did not receive medications in accordance with physician orders and labeling requirements. One hospice resident with COPD, chronic pancreatitis, and generalized anxiety disorder was ordered Lorazepam oral concentrate for terminal anxiety but was repeatedly given tablet doses instead, and the drug continued to be administered after it was discontinued. In a separate case, an RN was found using an unlabeled morphine oral solution bottle marked only with a handwritten number, later identified as belonging to a resident, and confirmed that this medication had been administered multiple times without proper labeling or resident identification.
Surveyors observed that medications were not stored securely and expired medications were not handled according to facility policy. On a crash cart, three packs of Tiotropium Bromide Monohydrate inhalation powder labeled for a resident, including one used inhaler with a past use-by date, were found sitting on top of an unlocked, unsecured cart. The ADON acknowledged these inhalers should not have been left unsecured and should have been placed in the designated medication room for expired medications, contrary to the facility’s written medication storage policy requiring secure access and removal and destruction of expired drugs.
Two CMAs were found to have access to keys for the locked narcotic box and medication storage room, contrary to facility policy and their job descriptions, which prohibit them from handling or administering narcotics. Both CMAs confirmed they held the keys and participated in narcotic count verifications, while nursing staff and administration confirmed that only nurses are authorized to access and dispense narcotic medications.
Surveyors observed that drugs and biologicals, including lorazepam and eye drops, were stored in unlocked refrigerators and lacked proper labeling. Expired intermittent catheters were also found in the medication storage room. Staff, including a CMA and an LPN, were unable to demonstrate knowledge of expiration dates or proper storage procedures, and the DON confirmed the presence of expired and improperly stored items.
A medication cart was left unlocked and unattended in a hallway, with its computer screen displaying resident information and drawers accessible, while a resident was nearby. The responsible RN acknowledged forgetting to lock the cart when leaving to refill a water jug, contrary to facility policy requiring medication carts to be locked when not in use.
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