| 4555 |
PIONEER HEALTH OF CENTRAL GEORGIA |
115564 |
712 PATTERSON STREET |
BYROMVILLE |
GA |
31007 |
2016-12-10 |
431 |
E |
0 |
1 |
QBL111 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the Clinical Program Manual dated 3/16 Medication Management 3F-2.2, In-service titled, Survey Preparedness, observations and staff interviews the facility failed to properly store , label and dispose of medications. Specifically, the facility failed to ensure timely removal of discontinued or expired medications in 1 out of 1 medication rooms observed and failed to label insulin and eye drops, and dispose of expired medication in 2 out of 2 medication carts assigned to the West unit. Findings include: Review of the medication management policy on 12/9/16 titled, the Clinical Program Manual dated 3/16, Medication Management section 3F- 2.2, stated, 12. Removed discontinued medications from the medication supply during the shift the medication is discontinued on. Store in a locked location, as identified by the facility, for disposition according to state and federal requirements. Manufacturing Guidelines: Novolog: Opened at room temperature or Refrigerator temperature good for 28 days Humalog: Opened at room temperature or Refrigerator temperature good for 28 days Humulin R: Opened at room temperature or Refrigerator temperature good for 28 days Humulin 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Humulin N: Opened at room temperature or Refrigerator temperature good for 28 days Novolin N: Humulin N: Opened at room temperature or Refrigerator temperature good for 28 days Novolin 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Novolog 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Lantus: Opened at room temperature or Refrigerator temperature good for 28 days Levemir: Opened at room temperature or Refrigerator temperature good for 42 days An in-service dated 12/2/16 titled, Survey Preparedness given by the Director of Nursing (DON) which stated in pertinent parts: .2. Medication management-all nurses are expected to administer medications in a timely manner, and document that the medication was given . Always date every medication when opening .Always check for expired meds and remove if found. Observations on the West Nurses Station: On 12/7/16 at 6:15 a.m. it was observed that there was a bottle of Hy[DATE].25% sodium hypochlorite solution for R#44 sitting out on the nurse's station as well as some unidentified bubble packs of medication delivered that morning. West Medication Storage Room: On 12/7/16 at 6:20 a.m. the medication room revealed the following; The thermometer in the medication refrigerator read 45 degrees Fahrenheit (F) Humalog opened 9/15/15 for resident (R) #82 was not dated on the bottle or on the packaging Humalog opened 9/14/16 for R#87 was not dated on the bottle or on the packaging Humalin opened 9/16/16 for R#27 was not dated on the bottle or on the packaging On 12/07/2016 7:31 a.m. the West medication cart was inspected the following was found; Lantus opened 9/21/16 for R#43 was not removed after 28 days Humalin R for R#27 was opened but not dated on the bottle or packageNovolog for R#71 was opened but not dated on the bottle or package Lantus for R#82 was opened but not dated on the bottle or package Medroxyprogesterone 150 mg/ml for R#26 vial was observed stored on the side in the medication cart although packaging stated it should be stored upright at all times Atropine 1% eye drops for R#27 was opened but not dated on the bottle or package Metoprolol Succ ER expired 11/30/16 for R#50 Omeprazole expired 9/30/16 and Carbamazepine expired 10/31/16 for R# 69 On 12/7/16 at 12:02 p.m. the West/East medication cart was inspected, the following was found' Lantus for R#1 was opened but not dated on the bottle or package Lantus for R#63 was opened but not dated on the bottle or package Levemir for R#78 was opened but not dated on the bottle or package Novolin 70/30 R#44 was opened but not dated on the bottle or package Levemir for R#70 was opened but not dated on the bottle or package Humalog for R#7 was opened but not dated on the bottle or package Alphagan eye drops opened 9/22/16 for R#77 Atropine eye drops opened 9/20/16 for R#68 R#56 Potassium and Divalproex Sodium expired 10/31/16 R#89 Zolpidem Tartrate, Senna Plus and Rena-vite expired 11/30/16 R#85 3 bubble packs of Lorazepam expired 11/30/16 R#43 Loperamide expired 11/30/16 Medication and Treatment Carts: On 12/8/16 at 6:47 a.m. LPN AO was observed going into room [ROOM NUMBER] her medication cart was not locked or within view and remained unattended until 6:50 a.m. when she returned. There were no resident's observed tampering with the cart. On 12/07/2016 10:40 a.m. the East hallway medication carts lock was observed pushed in half of the way, which meant it was not locked. The nurse for medication cart not in hallway. On 12/7/16 at 7:20 a.m. LPN AD left the East medication cart unlocked and walked down to the East nurses station leaving her cart unattended at the end of the East hallway. There were no resident's observed tampering with the medication cart. observed. It was unclear how long the cart had been unattended as LPN AH was observed on the East hallway, there were no resident's observed tampering with the cart. On 12/8/16 5:00 p.m. two certified nursing assistance (CNA) CNA AJ and CNA AO were observed on the East hallway by the nurse's station. The medication cart was unlocked and unattended in front of the nurse's station, CNA AJ stated that the nurse was in the shower room. At 5:05 p.m. the Assistant Director of Nursing (ADON) walked by and was shown the unlocked medication cart she stated, Oh no not again. On 12/8/16 at 5:07 p.m. LPN AD came out of the shower room. When asked what the policy was regarding the medication cart was she stated, The cart should be locked and I understand the danger of leaving it unlocked, I should have locked it. On 12/07/2016 11:51 a.m. the Unit Manager (UM) stated that the policy is that the medication carts be checked at the beginning of every shift for expired medications and if expired, discard and replace them, new prescription, date all medications when you open them. She discussed that opened insulin was kept for 30 days and when opened needed to be documented on the box and the bottle. She discussed that when expired medications are found they are discarded in the medication room, and all expired and discontinued medications are removed once a week. On 12/07/2016 12:02 p.m. Licensed Practical Nurse (LPN) AL stated that when you accept the medication cart you make sure you have all of the medications. She discussed that a bottle of insulin is good for 42 days, 28 days or 31 days depends on what type it is, and she did not identify the different types of insulin. LPN AL stated that when a bottle of eye drop or insulin is opened, you date it on the bottle and on the box, and if there is no date on the bottle or box check with nurses to see who opened if, check date delivered from pharmacy and who signed it in and then dispose and order a new bottle if it can't be determined when it was opened. She stated that medications are delivered after midnight like between 1:00 and 2:00 a.m. in the morning and once received the procedure is to sign off on the medications and put the medications in the appropriate place. She stated they must be stored in the medication cart or the medication room, never left on the nurse's station. On 12/07/2016 12:30 p.m. LPN AH stated that once medications are delivered from the pharmacy they should be put in the medication cart, refrigerator, or medication storage room. They should not be out on the desk, especially with the population they have. On 12/07/2016 12:53:37 p.m. the DON stated that she just in-serviced the nurses that they must check for expired medication on every shift on 12/2/16. She stated that insulin is to be dated when opened on the bottle and the box, eye drops dated on the bottle and box and they are generally good for 28 days or sooner, unless otherwise specified. |
2019-09-01 |