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Based on observations, record review and interview, the facility failed to ensure that staff directly handle medications appropriately and do not cross contaminate medications during medication administration for 1 of 4 patients observed. (Patient #13).

Findings:

1. Observation of medication administration at approximately 12:05 PM on 02/28/2012 revealed that the Medication Nurse #A preparing and administering medications for one patient without washing her hands or using a sanitizing gel before, administering medications to patient #13. The Medication Nurse bent down to opened the drawer to the medication cart, took out some medications, then placed the medications in their identified wrappers, in a plastic medication cup. When she went into patient #13's room to administer the medications, while administering each medication, she dropped the medication of Diltiazem (Cardizem) HCL Extended release (ER) 120 milligrams (mg.) on the unclean bedside table. Next she scooped up the Diltiazem with a plastic spoon and fork off the bedside table, placed it in applesauce and into the patient's mouth. Then she used the same plastic fork off the bedside table to stir a packet of Metamucil into a cup of water with 3 ounces of water, and administered the Metamucil medication to this patient.

2. Record review revealed that patient #13 was admitted on 02/23/2012 with a chief complaint of a fever, and a history of hypertension, coronary artery disease, peripheral arterial disease, osteoporosis, anxiety disorder, paraplegia, spinal infarction, bowel and bladder incontinence, ongoing right buttock skin breakdown, and was admitted for evaluation and treatment for urinary tract infection (urosepsis). Review of nurse's notes on 02/28/2012 at 9:30 AM, revealed that a stool sample was obtained from patient #13 and sent to the laboratory. At 12:30 PM patient #13's results had returned with a positive result for Clostridium Difficile Toxin (C-Diif).

3. During an interview on 02/29/2012 at 1:00 PM with the Chief Nursing Officer (CNO), he stated "whenever any nursing staff drop a medication, whether it fall to the floor or on a bedside table, they should discard the medication and obtain a new medication to administer."

Based on observation, record review and interviews it was determined that the facility failed to ensure that all drugs were kept in a locked storage area according to established policies and acceptable standards of practice as evidenced by failing to properly secure medications.

Findings:

1. During the initial tour of the operating room area conducted on 02/28/2012 at 12:05 PM, revealed an unlocked anesthesia medication cart in the presence of an unlicensed personnel (surgical scrub technician) and no licensed medical staff members in the operating room.

2. Interview on 02/28/2012 at 12:10 PM with the anesthesiologist confirmed that he had left the anesthesia medication cart unlocked and unsecured.

3. Interview with Director of Pharmacy on 02/28/2010 at 2:15 PM revealed that the Diprivan, (an anesthesia medication), and all the other medications on this anesthesia medication cart, should be stored under lock at all times.

4. Review of the facility's Policy and Procedures titled "Medication handling (storage, labeling, dispensing) revealed the following:
PURPOSE: To provide a general policy to ensure accurate and safe handling of medications.
STATEMENT: All medications will be stored, prepared, dispensed, and charted in accordance with the following protocol.
PROCEDURE:
1. To prevent loss of drugs:
A. Medication carts will be locked at all times when not in use.