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Based on observation, review of the North Dakota Administrative Code, and staff interview, the Critical Access Hospital (CAH) failed to limit access to the pharmacy in the absence of the pharmacist for 1 of 1 hospital pharmacy. This failure limited the CAH's ability to ensure administration of pharmaceutical services in accordance with accepted professional principles.

Findings include:

The North Dakota Administrative Code, Chapter 61-07-01 "Hospital Pharmacy" stated, ". . . 61-07-01-05. Absence of pharmacist. 1. General. During such times a hospital pharmacy may be unattended by a pharmacist, arrangements must be made in advance . . . for the provision of drugs . . . by use of night cabinets or floor stock, or both, and in emergency circumstances, by access to the pharmacy. . . . 3. Access to pharmacy. Whenever any drug is not available from floor supplies or night cabinets, and such drug is required to treat the immediate needs of a patient whose health would otherwise be jeopardized, such drug may be obtained from the pharmacy in accordance with the requirements of this section. . . ."

Observation of the pharmacy occurred on 02/25/14 at 2:00 p.m. with a pharmacy staff member (#1). The staff member (#1) stated his working hours as 8:30 a.m. to 2:30 p.m. Monday through Friday and stated the charge nurse accessed the pharmacy in his absence to obtain medications for patients. The pharmacy staff member (#1) also stated the charge nurse accessed the pharmacy to return outdated medications and obtain pre-made outpatient prescription medications for emergency room (ER) patients.

During an interview on 02/25/14 at 3:45 p.m., two staff nurses (#2 and #3) confirmed the charge nurse accessed the pharmacy to obtain take-home medications for ER patients and return outdated medications found on medication carts and in the medication room.