HospitalInspections.org

Based on observation, document review and staff interview it was determined the hospital failed to ensure all medications are locked in a cabinet or medication room or cart during medication pass. This deficient practice was identified in three (3) of four (4) medication carts observed. Failure to maintain locked medication drawers has the potential to adversely impact the care of all patients by increasing the risk of stolen medication from the unlocked medication carts which can result in late medications to patients and potentially harm the person(s) who steal and ingest the medication.

Findings include:

1. During a tour of the fourth (4th) floor patient care area on 8/25/15 from 10:30 a.m. to 11:10 a.m., three (3) unattended computer/medication carts, identified as carts LGGH4NC1, LGGH4NC3 and LGGH1CU1, were noted to have unlocked drawers containing patient medications, tablets, injectables and Novolog brand prefilled insulin injection devices.

2. Review of the policy titled, "Medication Storage and Delivery", last revised 6/2014, states, in part: "After leaving the pharmacy, medications are stored in locked medication rooms, automatic dispensing machines, medications carts and locked wall boxes. Once removed from these areas, the drug must remain with a staff member at all times and should not be left unattended."

3. The Chief Operating Officer and the 4th floor Nurse Manager were in attendance during the tour and concurred with the above findings.