| 71 |
MINOT HEALTH AND REHAB, LLC |
355031 |
600 S MAIN ST |
MINOT |
ND |
58701 |
2017-07-26 |
431 |
E |
0 |
1 |
GH6U11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, facility record review, and staff interview, the facility failed to ensure proper labeling and storage/disposal of medications on 3 of 3 days of survey (July 24-26, (YEAR)). Failure to ensure correct labeling of insulin pens (4 observations), lock an unattended medication cart (North Cart Second Floor), and properly dispose of a fentanyl patch (narcotic pain patch) may result in medication errors and allow access of unauthorized personnel, visitors, and/or residents to medications. Findings Include: LABELING OF MEDICATION Review of the facility policy titled Labeling of Medication Containers occurred on 07/26/17. This policy, dated (MONTH) 2007, stated, . 9. The nursing staff must inform the pharmacy of any changes in physician orders for a medication. - Observation during a medication pass on 07/24/17 at 5:25 p.m. showed a licensed staff nurse (#7) administered Novolog 4 units, as stated on the Medication Administration Record [REDACTED]. The current physician orders, dated 07/06/17, stated, decrease Novolog to 4 units three times daily with meals. The facility failed to update the medication label to coincide with the physician's order. - Observation on 07/25/17 at 8 a.m. showed a licensed staff nurse (#7) administered 20 units of Levemir insulin, as stated on the MAR, to Resident #7. The medication label stated, inject 30 units subcutaneously. The current physician order dated 07/08/17, stated, decrease Levemir to 20 units. The facility failed to update the medication label to coincide with the physician order. An interview occurred on 07/24/17 during the medication pass; a licensed nurse (#7) stated when an insulin dose changes pharmacy does not change the label. - Observation during a medication pass on 07/25/17 at 8:46 a.m. showed a staff nurse (#1) administered Levemir insulin 15 units, as stated on the MAR, to Resident #16. The medication label stated inject 10 units subcutaneously at bedtime. The current physician orders, dated 07/03/17, stated, increase Levemir insulin to 15 units subcutaneously twice a day. The facility failed to update the medication label to coincide with the physician's order. On 07/26/17 at 9:45 a.m. two staff nurses (#1 and #2) identified nursing staff should contact the pharmacy to get new labels for the insulin when the order is changed. STORAGE OF DRUGS Review of the facility policy titled Administering Medications occurred on 07/26/17. This policy, revised (MONTH) 2012, stated, . During administration of medications, the medication cart will be kept closed and locked when out of sight of the medication nurse or aide. Observation on 07/24/17 at 5:21 p.m. showed an unlocked medication cart on the north hallway of the 2nd floor, and the nurse seated at the nurses' station (not in view of the cart). Observations at 5:27 p.m., 5:39 p.m., 5:46 p.m., and 5:53 p.m. showed the cart remained unlocked and the nurse was not in view of the cart. Observation at 6:02 p.m. showed the cart locked. DISPOSAL OF MEDICATION Review of the facility policy titled, Administering Topical Medications occurred on 07/26/17. This policy, dated (MONTH) 2010, stated, . Trans-dermal patches . Discard all disposable items into designated containers. Review of Resident #4's medical record occurred on all days of survey. Medical [DIAGNOSES REDACTED]. The current physician's order, dated 06/29/17, identified Fentanyl 12 MCG (micrograms)/HR (hour) patch. Apply 2 patch (sic) every 3 days for pain. Check placement daily. Discard old patch. Observation on 07/25/17 at 3:40 p.m. showed a staff nurse (#6) applied gloves, removed a Fentanyl patch (trans-dermal patch) from the right side of Resident #4's chest, disposed of it in the garbage can next to the resident's bed, and exited the room. During an interview on 07/26/17 at 8:45 a.m., an administrative staff member (#3) verified she expected staff to dispose the trans-dermal patch in the sharps container located on the medication cart along with another nurse to witness the disposal of the patch. |
2020-09-01 |