cms_HI: 75
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 75 | HALE MAKUA - KAHULUI | 125007 | 472 KAULANA STREET | KAHULUI | HI | 96732 | 2019-11-26 | 761 | D | 0 | 1 | 6SOG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to: label the blister back for a blood pressure medication with the correct dose for one Resident (R)47 which would place the resident at high risk for injury due to receiving the wrong medication and/or the wrong dose of medication; appropriately discard an antibiotic ointment medication from the treatment cart (the label was non-readable); and failed to label medications with discharge date s. Findings include: 1) During a medication administration observation with LN52 noted a blister pack for R47, the medication was [MEDICATION NAME] (a medication to decrease blood pressure) give 25 milligram (mg) tab 37.5 mg (1.5 tabs) by mouth (PO) twice per day (BID) Diagnosis: [REDACTED]. A hand written note in black ink was noted on the top left corner of the blister pack that stated direction changed, refer to chart. When asked what the correct dosage for R47 was LN52 stated, the new dose was just changed and the new order states to give 25 mg (1 pill) BID. We were giving 25 mg, 1-1/2 tabs, daily which totals 37 mg. LN52 verified that the dosage was changed and now R47 receives only one 25 mg tab, and the label on the blister pack does not reflect the new dose. Medical record reviewed. The Medical Doctor (MD) order dated 11/02/19 states [MEDICATION NAME] 25 mg tabs. Give 1 tab PO BID. During an interview with LN52 on 11/22/19 at 11:00 AM, discussed the labeled blister pack. LN52 stated that in a situation where the order is changed and the medication is the same but the dosage is changed, normally the new dose is written on the top left corner of the blister pack and highlighted in yellow. The nurses normally don't cross out the old dosage information and will continue to use the medication in the blister pack until it runs out. LN52 further explained, since each blister has 1-1/2 tabs, and the order is now 1 tab, they will use the whole tab, then the half tabs (2) until they are all gone or there is only one half tab left. During an interview with the Charge Nurse (CN) on 11/22/19 at 11:21 AM who stated that when we have an order for [REDACTED]. The CN concurred that the blister pack for the [MEDICATION NAME] should be immediately discarded and a new blister pack is obtained from the pharmacy with the correct dose. 2) During a random inspection of the medication/ treatment cart on 11/22/19 at 11:02 AM in the Pikake neighborhood a small tube of Mupirocin (an antibiotic) ointment was found in a drawer. The label appeared old with the print completely worn off making it non-readable. When Licensed Nurse (LN)52 was asked if he knew which resident it belonged to or when the expiration date for the ointment was, LN52 responded that its very hard to tell which resident, I can't see the name . I think we should throw it away. 3) On 11/22/19 at 08:58 AM an inspection of the medication cart on the Ilima Unit was done with the assistance of Licensed Nurse (LN)2. The observation found a vial of [MEDICATION NAME] labeled with an opened date of 10/26/19 with no discard date. Inquired when is insulin discarded, LN2 responded after 28 days and confirmed the discard date should have been written on the label. Observation of other opened vials of insulin found it was labeled with a discard date. Further queried what is the discard date for this vial. LN2 asked another nurse how long before insulin is discarded, the nurse responded 28 days but for [MEDICATION NAME] it is 42 days. LN2 calculated the dates and stated this vial is to be discarded tomorrow (11/23/19). Further inspection found an opened bottle of lantoprost (eye drops for [MEDICAL CONDITION]) labeled with an open date of 11/17/19. LN2 was asked when is this medication discarded. LN2 replied, she thinks it is 30 days and confirmed there was no discard date documented on the label. During the exit conference on 11/27/19, the facility staff reported labeling medications with the discharge date is not required. At this time, a request was made for the pharmacy policy regarding labeling of medications. The facility was agreeable to provide the pharmacy policy and procedure via facsimile. On 12/03/19, the facility sent a policy and procedure entitled Medication Storage, Storage of Medication. The procedure notes the following: 12. Insulin vials should be stored in the refrigerator until opened. Date insulin vials when first opened, may store opened vial in refrigerator or at room temperature. Do not freeze insulin. If insulin frozen, do not use (Refer to Section 9.12, Expiration Dating). Correspondence through e-mails with the Administrator from 12/03/19 to 12/04/19 found the facility was unable to provide Section 9.12, Expiration Dating or a policy and procedure related to labeling medications with expiration date. | 2020-09-01 |