Health inspection·January 6, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to accurately label insulin with resident's name and date of opening for 6 (R3, R7, R11, R14, R16, R37) of 12 residents reviewed for medication labeling and storage in a sample of 26. Findings include: On [DATE] at 10:10AM, the medication cart serving rooms 100 through 308 was observed to have 1 Novolog Flexpen with no name or open date, 2 of R14's Humalog Kwikpens with no open date, 1 Levemir Flextouch with no name or open date, 1 Humalog Kwikpen with no name or open date, 1 of R11's Basaglar pens with no date, 1 Lantus vial with no name or date, and 1 of R14's Lantus vials with no open date. V4 (Registered Nurse/RN) said all the insulins should be labeled with the resident's name and date of opening. R7's face sheet documented an admission date of [DATE] and diagnoses including: hypertension, heart failure, major depressive disorder. R7's Physician Order Sheet (POS) documented an [DATE] order for Lantus 100 unit/ ml (milliliter) 25 units every morning. R11's face sheet documented an admission date of [DATE] and diagnoses including: hypertension, anxiety disorder, cerebral infarction, fatty liver. R11's POS documented a [DATE] order for Basaglar 100 unit/ ml 35 units at bedtime, an [DATE] order for Novolog 100 unit/ ml 8 units 3 times a day before meals, and a [DATE] order for Novolog 100 unit/ ml sliding scale three times a day. R14's face sheet documented an admission date of [DATE] and diagnoses including: anxiety disorder, type 2 diabetes mellitus, hypertension. R14's POS documented a [DATE] order for Lantus 100 unit/ ml 12 units twice a day, [DATE] order for Humalog 100 unit/ ml sliding scale twice a day. R37's face sheet documented an admission date of [DATE] and diagnoses including: anemia in chronic kidney disease, end stage renal failure, type 2 diabetes mellitus, hypertension. R37's POS documented a [DATE] order for Humalog 100 unit/ ml 3 units with meals three times daily, and a [DATE] order for Humalog 100 unit/ ml sliding scale twice a day. On [DATE] at 1:38PM, V2 (Director of Nursing/DON) said R7, R11, R14, and R37 were the only residents served from the 100 through 308 medication cart with orders for the types of undated insulins found. Page 1 of 2 145890 145890 01/06/2023 Eldorado Rehab & Healthcare 1001 A Jefferson Street Eldorado, IL 62930

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On [DATE] at 9:56AM, the medication cart serving rooms 400 through 504 was observed to have 2 Basaglar pens with no name or open date, 2 Novolog Flexpens with no name or open date, 2 Levemir Flextouch with no name or open date, 1 Humalog Kwikpen with R16's name written on it but no opened date. V5 (Licensed Practical Nurse/LPN) said he was unsure who the different insulins belonged to because he mostly worked dayshift and those different type of insulins were given on a different shift. V5 said the resident's name and date of opening should be written on them. R3's face sheet documented an admission date of [DATE] and diagnoses including: chronic diastolic heart failure, type 2 diabetes mellitus, anemia in chronic kidney disease. R3's POS documented a [DATE] order for Levemir 100 unit/ ml 20 units every morning, and a [DATE] order for Levemir 100 units/ ml 10 units every night. R16's face sheet documented an admission date of [DATE] and diagnoses including: heart failure, anxiety disorder, major depressive disorder, obstructive sleep apnea. R16's POS documented a [DATE] order for Basaglar 100 unit/ ml 40 units twice a day, a [DATE] Humalog 100 unit/ ml sliding scale twice a day. On [DATE] at 1:38PM, V2 (DON) said R3 and R16 were the only residents served from the 400 through 504 medication cart with orders for the types of undated insulins found. V2 said all insulin pens and vials should have the resident's name and date of opening on them. V2 said once insulin pens and vials are opened, they have an expiration date depending on the type of insulin some being 28 days and some being 31 days. V2 said if there was no open date on the insulin, staff would not know when the insulin becomes expired. V2 said all insulins in the medication cart belong to specific residents and no multidose insulin pens or vials were stock medications used for multiple residents. The facility's [DATE] Insulin Administration policy documented in part .5. The nursing staff will have access to specific instructions . on all forms of insulin delivery system(s) prior to their use 8. Facility will follow the manufacturer guidelines for stability of insulins and pens. For storage and use . the vial or pen should be dated when it is opened .Stability of Common Insulins in Vials and Pens . Opened at Room or Refrigerator Temperature (days): Novolog FlexPen 28 days, Levmir FlexPen 42 days, Basaglar 28 days, Humalog 28 days, Lantus 28 days . 145890 Page 2 of 2