Medication labeling and storage were not maintained according to policy. Surveyors found an opened and undated Tubersol vial in one storage area and multiple expired, opened without dates, or otherwise unlabeled medications in several medication carts, including eye drops, eye ointment, inhalers, and nasal sprays. An LPN, RN, and DON confirmed the findings, and the medications were removed from storage.
Improper storage of expired medications and biologicals was found in 2 medication rooms. Surveyors observed expired Augmentin bottles in active storage, an opened Aplisol vial that was not dated when opened despite manufacturer instructions to discard after 30 days, and expired fecal occult blood test kits on a shelf near the refrigerator. RN and LPN staff verified the expired items, and the DON stated the items should not have been left in active storage and that Aplisol should have been dated when opened.
Improper medication storage was identified when surveyors found loose pills in 3 of 3 med carts, along with a Ziploc bag of Pro-stat packets with liquid in the bottom of the bag. The facility policy stated medications are to be kept in their containers and compromised or deteriorated med packs are to be discarded upon discovery. An LPN confirmed the loose pills and removed them, and staff interviews showed differing practices for cart cleaning and that loose pills should be discarded when found.
Expired Aspirin was found in a medication cart with in-date medications in 1 of 4 carts reviewed. The facility policy assigned nursing staff responsibility for maintaining medication storage and preparation areas, and an LPN confirmed the expired bottle during observation and removed it from the cart.
Surveyors found that nursing staff did not consistently follow the facility’s medication storage policy, resulting in expired and improperly stored medications on multiple medication carts. On one cart, an opened Insulin Aspart vial remained available for use past its expiration, and Promethegan suppositories labeled for refrigeration were stored at room temperature. On another cart, several Insulin Aspart FlexPens and a Liraglutide injection pen lacked required open dates or usable dating, and on a third cart, expired Alprazolam tablets remained in the drawer despite having been administered previously. These issues showed that outdated medications and undated insulin and injectable products were stored with medications in active use.
Surveyors found expired Hydroxyzine tablets and two bottles of Fluticasone nasal spray without caps stored on medication carts. Nursing staff confirmed the deficiencies, and interviews with the DON, pharmacist, and administrator indicated that medications without caps should be discarded and replaced, in line with facility policy.
A resident was found with an unattended cup of Guaifenesin (Robitussin) at the bedside, and a loose pill of Sulfamethoxazole and Trimethoprim was discovered without documentation or provider orders. Nursing staff could not account for the medications, and no self-administration assessment or authorization was present. Facility policy requiring provider orders, proper documentation, and secure storage of medications was not followed.
Surveyors found that an insulin pen in use was missing required labeling, including the open and expiration dates, and an expired nasal allergy spray was stored with current medications. Both issues were confirmed by LPNs and involved two of eight medication carts reviewed, in violation of facility policy for medication storage and labeling.
Surveyors observed expired and non-sterile biologicals, including dressings and antimicrobial products, stored on a treatment cart. The DON confirmed these items were expired or no longer sterile, indicating a failure to remove outdated or compromised supplies as required by facility policy.
Surveyors identified that insulin pens and prefilled syringes were not consistently labeled with open or expiration dates, and some unopened insulin products were not refrigerated as required. Nursing staff interviews confirmed that responsibility for labeling and storage was shared among pharmacy, unit managers, and nurses, but lapses occurred, including expired and unlabeled insulin remaining on medication carts.
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