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Based on observation, policy review, and staff interview, the facility failed to ensure that drugs and biologicals were secured in one (Operating Room 2) of three operating rooms during the delivery of surgical services. Findings include:

On 6/5/12, beginning at 7:30 a.m., the surveyor began observations in the surgery areas. During observations of staff cleaning operating room 2 between cases, the surveyor observed the anesthesia cart dedicated to that room. After staff completed the wipe down of the room, there were no staff in the room. At approximately 9:00 a.m., the surveyor, accompanied by staff member C, walked to the anesthesia cart and found the cart to be unlocked. Staff member C expressed surprise that the anesthesia cart was unlocked. The cart contained a full complement of anesthesia medications including Diazepam.

The surveyor began a review of the contents of the cart. The surveyor noted expired medications and intravenous therapy supplies in the cart. Approximately 10 minutes after beginning the review, the nurse anesthetist entered the room and asked the surveyor and staff member C who had unlocked his anesthesia cart. Both the surveyor and staff member C stated that at the beginning of the review, the cart was not locked.

The surveyor requested, and received, the facility-wide policy for storage of medications on 6/5/12 at approximately 2:00 p.m. During the review of the facility policy labeled " Pharmacy Administration, Storage, Requisition, and Preparation of Medications at NMH (Northern Montana Hospital)", the surveyor did not note a reference in the policy statement about securing or locking of medications or medication carts in the operating rooms.

In an interview with staff member C on 6/5/12 at approximately 9:20 a.m., staff member C stated that the nurse anesthetists were responsible for the contents of their carts and each nurse anesthetist had the only key to the assigned cart.

Based on observations and a staff interview, the facility failed to ensure that outdated, mislabeled, or otherwise unusable drugs and biologicals were not available for patient use in 4 (Intensive Care Unit (ICU), Operating Rooms (OR), Same Day Center (SDC), and Obstetrics (OB)) of 7 patient care areas of the hospital. Findings include:

1. On 6/4/12, at approximately 2:00 p.m., the surveyor noted an open vial of 70/30 insulin in the ICU refrigerator. The vial was not marked with the date that the vial was first accessed. There was no means of learning how long the vial had been open and if it was safe to use.

2. On 6/5/12, beginning at 7:30 a.m., the surveyor noted the following medications available for patient use in the OR area:
-12 glass 1 milliliter ampoules of Epinephrine 1:1000, with the manufacturer's expiration date of 1/13/2012.
-1 open 30 milliliter single dose vial of Vancomycin 1 gram, the vial was not marked with the date the vial was first accessed.
-1 vial Triesence injectable, 40 milligrams per milliliter, with the manufacturer's expiration date of 1/2012.
- 1 purple pharmacy stock medication box in Operating Room 2 that was labeled with the contents and expiration dates of the medications in the box. According to the label, there were medications that had expired in April, May and the 1st of June of 2012. The labels were observed for those medications and were found to be accurate.
-1 Vercupam 5 milligram vial with the manufacturer's expiration date of January 1, 2012.
-1 Ketorolac 60 milligram vial with the manufacturer's expiration date of February 1, 2012.

3. The surveyor noted in the SDC area an open multi-dose vial of 1% Lidocaine for injection that was not labeled with the date the vial was first accessed.

4. The surveyor noted 2 Lidocaine 2% jelly 10 milliliter injectors in the OB area with the manufacturer's expiration date of 2/2012.

On 6/5/12, at approximately 9:20 a.m., staff member C stated that pharmacy staff check the pharmacy stock medication boxes for expiration dates of medications monthly, and replace those medications and change the labels on the boxes. Staff member C stated that the nurse anesthetists were responsible for the contents of the anesthesia carts in the operating rooms and were supposed to check the contents monthly.

Based on observations and staff interview, the facility failed to ensure that patient care supplies were maintained to an acceptable level of safety and quality in 3 (Operating Rooms (OR), Same Day Center (SDC), and Obstetrics (OB)) of 7 patient care areas. Findings include:

1. On 6/5/12 beginning at 7:30 a.m., the surveyor reviewed the OR's and surgery area of the facility, and noted the following expired patient care supplies:
-1 Portex Pro-Vent arterial blood gas kit with the manufacturer's expiration date of 7/2010.
-2 Valmet 2 milliliter blue top vacuum blood collection containers with the manufacturer's expiration date of 2/2012.
-4 SPS Vacutainer 3.32 milliliter yellow top blood collection containers with the manufacturer's expiration date of 2/2012.
-1 Becton-Dickinson Nexia Intravenous catheter with the manufacturer's expiration date of 5/2011.
-3 Insyte ProtectIV 16 gauge by 1.25 inch intravenous catheters with the manufacturer's expiration date of 10/2008 in the operating room 2 anesthesia cart.

2. On 6/5/12 beginning at 7:30 a.m., the surveyor reviewed the Same Day Surgery area of the facility, and noted the following expired patient care supplies:
-5 Insyte ProtectIV 16 gauge by 1.25 inch intravenous catheters with the manufacturer's expiration date of 8/2010.
-1 Becton-Dickinson Culture swab with the manufacturer's expiration date of 10/2010.

3. On 6/5/12, at approximately 1:30 p.m., the surveyor reviewed the Obstetrics/Nursery area of the facility and noted the following expired patient care supplies:
-30 Glucochlor disinfectant wipes with the manufacturer's expiration date of 3/2012.
-16 4 ounce bottles of premixed Prosobee infant formula with the manufacturer's expiration date of 1 April 2012.
-1 open 8 ounce bottle of Hibiclens skin disinfectant solution with the manufacturer's expiration date of 7/2011.
-36 foil packages of 5-0 Vicryl suture on RB1 cutting needles with the manufacturer's expiration date of 1/2012.

In an interview with staff member C on 6/5/12 at approximately 9:00 a.m., the staff member stated that the staff checked supplies for expiration dates and the technician for central stores made rounds monthly to check the expiration dates of supplies.