I’ve put together a list of assisted living medication deficiencies to help you all learn some of the things a consultant pharmacist looks out for. These deficiencies are from the state of Minnesota and were collected in 2025 – 2026. A consultant pharmacist in assisted living facilities focuses on medication safety, optimization, and regulatory compliance for residents. They typically perform monthly or quarterly (sometimes every 6 months) medication regimen reviews to identify drug interactions, inappropriate medications, duplications, dosing problems, and opportunities for deprescribing. Consultant pharmacists work with physicians, nurses, and facility staff to recommend medication changes that improve safety and outcomes, particularly for older adults who often have multiple chronic conditions.

Consultant pharmacists also help ensure compliance with state and federal regulations, assist with medication policies and procedures, and may participate in quality assurance programs at the direction of the facility. Education is another key role—consultant pharmacists train staff on medication administration, high-risk medications, and safe storage practices. Overall, the consultant pharmacist acts as the medication expert for the facility, helping reduce adverse drug events, reduce the likelihood of assisted living medication deficiencies, and improve the quality of care for residents. When working in my role, I ultimately want to minimize the number of assisted living medication deficiencies given by the state department of health or federal surveyors. Here are numerous examples of Minnesota survey deficiencies that I hope you can learn from.

• Lorazepam order changed from every 8 hours to every 6 hours without a provider order
• Latanoprost ophthalmic drops did not include a label identifying the date opened or a discard date (expires in 6 weeks when removed from the fridge)
• Stored medications in an unlocked closet in the hallway on the main floor
• The record lacked documentation for medication setup at the time of setup, including the dates of medication setup, name of the medication, quantity of dose, times to be administered, route of administration, and name of the person completing medication setup
• The record lacked signed prescriber orders
• Unsecured medication in a fridge and an unlocked office
• Insulin did not bear an original prescription label, including open or expiration dates
• OTC medications were accessible to all residents in the facility (inadequate storage)
• Lack of monitoring of the medication refrigerator temperature
• Medication administration performed by an unlicensed staff member
• Trelegy Ellipta with no open date (should be discarded after 6 weeks or when counter is at 0
• Medications were not charted as being given in the medication administration record
• The medication refrigerator lacked a thermometer to monitor temperature
• No lock or temperature log for the medication refrigerator
• Signed physician orders in the record, but they were not on the MAR or did not match
• Medications on the MAR, but there were no signed orders in the record
• Lack of medication disposal records upon patient discharge/death
• Expired medications were found in a medication cart
• Unlocked medication cart

If you are looking for more information on consultant pharmacy, be sure to check out my course on long-term care consulting, which contains great information pertaining to some of the issues and concerns relating to geriatric care, long-term care, and assisted living. Insider’s Guide to Long Term Care Consulting

Special thanks to Maddie Detra, PharmD Candidate, for collecting the data on these deficiencies.