HospitalInspections.org

Based on observations and staff interview, the facility failed to ensure that supplies in the ER were available and not expired. Findings include:

During the review of the ER on 1/3/12 at 12:30 p.m., the following expired supplies were noted:
- 1 Robertazzi nasopharyngeal airway, 26 French, with the manufacturer's expiration date of 7/11;
- 2 BD Nexiva closed IV catheter system, 22 gauge, with the manufacturer's expiration date of 12/10;
- 1 Allegiance urological catheter, 8 French, with the manufacturer's expiration date of 5/11;


23084

- 2 urological catheters, 8 French, with a manufacturer's expiration date of 11/11;
- 1 urological catheter, 12 French, with a manufacturer's expiration date of 2/11;
- 1 urological catheter, 14 French, with a manufacturer's expiration date of 7/11;
- 4 oral/nasal tracheal tubes with a manufacturer's expiration date of 5/11;
- 1 oral/nasal tracheal tube with a manufacturer's expiration date of 1/99;
- 1 oral/nasal tracheal tubes with a manufacturer's expiration date of 11/95; and
- 2 pediatric tracheal tubes with a manufacturer's expiration date of 6/97.

When interviewed during the ER inspection, staff member A, the DON, verified the expiration dates of the above listed items.

Based on record review and staff interview, the facility failed to ensure 2 (#s 15 and 18) were seen by the medical provider within 30 minutes of their arrival at the ER. Findings include:

1. Patient #15 arrived at the ER on 8/23/11 at 7:27 a.m. with complaints of nausea and vomiting. According to the ER form, the provider was notified at 7:30 a.m. The area for the time the provider arrived was marked with "n/a." The patient was discharged at 7:41 a.m., after a dose of Phenergan was administered by the nurse. According to the documentation, the patient went to the clinic later that day and returned to the ER at 3:55 p.m. The provider was notified at 4:12 p.m., and arrived at 5:19 p.m., over an hour after being notified. At 8:20 p.m., the patient was transferred by ambulance to another hospital for acute appendicitis.

2. Patient #18 arrived at the ER on 9/24/11 at 4:28 a.m. following an assault with possible multiple facial fractures. The provider was notified at 4:37 a.m., and arrived at 6:10 a.m., over an hour and a half after being notified. The patient was discharged home at 6:22 a.m.

3. During an interview with staff members A and B on 1/4/12 at 4:15 p.m., the staff members stated they have been having issues with a particular provider who is on-call and not coming into the facility promptly. They have attempted to work with him, and he will get better for a while, then it's back to being slow on coming into the ER. The provider in question did talk with the surveyors during this meeting.

Based on observations and staff interview, the facility failed to ensure that outdated and mislabeled (without a modified open date) drugs were not available for patient use . Findings include:

During the inspection of the medication storage area conducted on 1/3/12 at 2:30 p.m., the following drugs were noted:

-2 opened multi-dose vials of injectable Anectine 200 mg/10 ml without a modified open date; and
-1 opened multi-dose vial of PPD with a modified open date of 11/14/11 and manufacturer's instructions to "discard after 30 days" of use.

When interviewed during the medication storage area inspection, staff member A, the DON, verified the undated and expired items listed above.

Based on observations and staff interview, the facility failed to ensure that supplies in the laboratory were available and not expired. Findings include:

During the inspection of the laboratory conducted on 1/3/12 at 12:40 p.m., the following expired supplies were noted:

- 50 bilirubin specimen collection tubes with a manufacturer's expiration date of 7/11;
- 1 opened bottle of hydrogen peroxide with a manufacturer's expiration date of 4/10; and
- 50 blue topped blood specimen collection tubes with a manufacturer's expiration date of 6/11.

When interviewed during the laboratory inspection, staff member A, the DON, verified the expiration dates of the above listed items.

Based on record review and staff interview, the facility failed to ensure 3 (#s 12, 15, and 13) of 25 sampled records were completely documented. Findings include:

1. Patient #12 arrived at the ER on 9/1/11 at 12:19 p.m. The nurse documented in the areas where the time the provider was notified and when the provider arrived "onsite." The patient was discharged from the ER at 3:15 p.m.

2. Patient #13 arrived at the ER on 8/17/11 at 12:20 a.m. There were no times noted for when the provider was notified or when the provider arrived. The patient was discharged from the ER at 1:30 a.m.

3. Patient #15 arrived at the ER on 8/23/11 at 7:27 a.m. with complaints of nausea and vomiting. The provider was notified at 7:30 a.m. The area for the time the provider arrived was marked with "n/a." The patient was discharged at 7:41 a.m. after a dose of Phenergan was administered by the nurse. According to the documentation, the patient went to the clinic later that day and returned to the ER at 3:55 p.m. The provider was notified at 4:12 p.m., and arrived at 5:19 p.m. At 8:20 p.m., the patient was transferred by ambulance to another hospital for acute appendicitis.

4. During an interview with staff members A and B on 1/4/12 at 4:15 p.m., the nursing staff is supposed to document the times rather than to write onsite or here.

Based on record review and staff interview, the facility failed to ensure that 1 (#24) of 5 death records reviewed listed the OPO was notified when the patient expired. Findings include:

1. Patient #24 was admitted to a swing bed on 8/11/11 with end stage liver disease. The patient expired on 8/13/11. There was no evidence in the record of the OPO being notified of this resident's death.

2. During an interview with staff members A and B on 1/4/12 at 4:15 p.m., the staff members stated that all deaths should be reported to the OPO. Neither staff member could say why the OPO was not notified of this patient's death. Staff member A stated she would try to locate more information. At the time of the exit on 1/5/12 at 10:15 a.m., no further information had been received.