Based on observation, record review, review of facility policy, and staff interview, the facility failed to ensure a medication error rate of less than five percent for 1 of 8 residents observed during medication administration (Resident #13). Three medication errors occurred during staff administration of 30 medications, resulting in a 10% error rate. Failure to properly prepare and administer medications may result in residents receiving an ineffective dose and experiencing adverse reactions. Findings include: Review of policy titled Insulin Administration- PEN occurred on 11/22/22. This policy, revised January 2018, stated, . H. remove the cap from the pen and wipe the rubber stopper with an alcohol wipe. I. Attach a needle to the insulin pen following manufacturer's guidelines. J. Perform an air shot [prime]. K. Turn dose selector to 2 units. L. Holding pen with the needle point up, tap the cartridge. 1) This moves any collected air to the top of the cartridge. M. Press the injection button all the way in until the dose selector is back to 0. 1) A stream or drop of insulin should appear at the tip of the needle. 2) If no drop appears, follow specific pen guidelines for additional testing. Review of Resident #13's medical record occurred on 11/22/22. Orders included: * 8/24/2022, Novolog FlexPen U-100 Insulin (insulin aspart) 100 unit/milliliter (ml), subcutaneous, 5 units, once a day. * 09/14/2022, Basaglar KwikPen U-100 Insulin (insulin glargine) 100 unit/ml, subcutaneous, 76 units, once a morning. Observation of medication administration on 11/22/22 at 8:55 a.m. for Resident #13, showed a nurse (#2) prepared a Basaglar insulin pen. The nurse (#2) wiped the tip of the insulin pen with an alcohol swab, applied a needle, and without removing the needle cap dialed the pen to two units and held the pen horizontally to prime the pen. The nurse (#2) dialed the pen to 17 units which was the amount left in the pen. The nurse (#2) obtained a new Basaglar insulin pen, wiped the tip of the insulin pen, applied a needle, and without removing the needle cap dialed the pen to two units, held the pen horizontally, primed the pen and dialed the syringe to the remaining units to equal 76 units as ordered. The nurse (#2) obtained a Novolog insulin pen, wiped the tip of the insulin pen, applied a needle, and without removing the needle cap dialed the pen to two units, and held the pen horizontally to prime the pen before she dialed the pen to five units as ordered. The nurse failed to follow the facility policy by priming insulin pens held horizontally versus vertically. During an interview on 11/23/22 at 11:45 a.m., an administrative staff member (#1) stated the nurse should follow the manufacturer's instructions and facility policy for priming of insulin pens.