| 39 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2019-04-18 |
761 |
E |
0 |
1 |
D2B811 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, facility staff failed to ensure opened multi-dose vials of insulin, being administered to residents, were dated when opened, and not being used past the open-expiration date of 28 days, for 3 (#s 17, 33, and 46) of 31 sampled and supplemental residents; and failed to ensure the storage of medications, including narcotics, found in the Emergency Kit (E-Kit) were properly secured on the 300 hall. Findings include: Insulin Pens without Open Dates 1. During an observation and interview on [DATE] at 10:14 a.m., of the Mountain View medication cart, with staff member N, three insulin pens for residents #17, #33, and #46, were found without an open date. Staff member N stated she did not administer insulin and therefore had no knowledge by whom, or when, the pens had been opened. During an interview on [DATE] at 10:50 a.m., staff member L stated she had opened and had administered insulin pens to residents #17, #33, and #46, earlier that morning. Staff member L stated she had forgotten to date each insulin pen, after opening, and had dispensed the unit dosages to the residents. Staff member L stated she should have ensured all insulin pens had been dated when opened. Staff member L proceeded to date each pen, [DATE], with a black marker. Staff member L stated the facility policy and procedure was to date when opened, multi-dose, insulin pens immediately after being opened and administered to the residents. a. Resident #17 was admitted to the facility with [DIAGNOSES REDACTED]. A review of resident #17's (MONTH) 2019 Medication Administration Record [REDACTED]. The start date was [DATE] at 6:00 a.m. b. Resident #33 was admitted to the facility with [DIAGNOSES REDACTED]. A review of resident #33's (MONTH) 2019 MAR indicated [REDACTED]. The start date was [DATE] at 8:00 a.m. c. Resident #46 was admitted to the facility with [DIAGNOSES REDACTED]. A review of resident #46's (MONTH) 2019 MAR indicated [REDACTED]. The start date was [DATE] at 6:00 p.m. A review of the facility's policy, Storage and Expiration of Medications, Biologicals, Syringes and Needles, read, .4. Facility should ensure that medications and biologicals that: (1) have an expired date on the label; (2) have been retained longer than recommended by manufacturer or supplier guidelines .are stored separate from other medications until destroyed or returned to the pharmacy or supplier. 5. Once any medication or biological package is opened, Facility should follow manufacturer/supplier guidelines with respect to expiration dates for opened medications. Facility staff should record the date opened on the medication container when the medication has a shortened expiration date once opened .12. Controlled Substances Storage: 12.1 Facility should ensure that Schedule II - V controlled substances are only accessible to licensed nursing, Pharmacy, and medical personnel designated by Facility .Facility should ensure that Scheduled II - V controlled substances are immediately placed into a secured storage area (i.e., a safe, self-locked cabinet, or locked room, in all cases in accordance with Applicable Law. 12.3 Facility should ensure that all controlled substances are stored in a manner that maintains their integrity and security. Unsecured E-Kit medications 2. During an observation and interview on [DATE] at 1:06 p.m., of the medication storage room on the 300 hall, with staff member S, there was an unsecured E-Kit with medications, including narcotics. Staff member S stated the E-Kit had not been locked for the last six months. Staff member S stated the management staff, and the unit manager, were aware of the unsecured E-Kit. During an interview on [DATE] at 1:15 p.m., staff member U stated the E-Kit had never been kept locked, and two nurses had keys to the medication room, where the kit was kept. During an interview on [DATE] at 1:28 p.m., staff member A stated she had not been aware of the unsecured E-Kit on the 300 hall. During an interview on [DATE] at 9:31 a.m., staff member R stated he was aware of the cabinet not locking. He stated he had the information in his monthly reports for the past few months. Staff member R said ideally the narcotics should be double locked per the regulations. |
2020-09-01 |