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Based on observation, review of manufacturer's instructions, and staff interview, the Critical Access Hospital (CAH) failed to ensure a preventative maintenance program for 1 of 1 automated external defibrillator (AED) at the off-site medical clinic. Failure to ensure staff maintained equipment critical to patient health and safety in safe operating condition, such as an AED, could result in serious injury or death if the equipment failed to function properly.

Findings include:

Observation of the off-site medical clinic occurred on 01/13/15 at 3:40 p.m. with an administrative staff member (#1) and a nurse (#2) and showed an AED stored in the nurses station at the back of the clinic. Observation of the AED failed to include evidence of completed maintenance. The nurse (#2) stated clinic staff did not check or perform any type of preventative maintenance on the AED and identified EMS (emergency medical services) staff maintained the AED.

During an interview on 01/15/15 at 9:40 a.m., an EMS staff member (#3) stated he did not perform routine maintenance on the AED nor check the AED's manufacturer's instructions for routine maintenance requirements.

Review of the Cardiac Science "Power Heart AED G3 Pro" operation and service manual occurred on 01/15/15. The manual, dated 2010, number 112-2034-401 Revision A, Section 6, Page 49, stated, "Scheduled Maintenance. Daily Maintenance: Check the status indicator to ensure that it is green. When the indicator is green, the AED is ready for a rescue. If the indicator is red, refer to the troubleshooting table in this chapter. Monthly Maintenance . . . 2. . . . Observe the change of the status indicator . . . 3. Check the expiration date on the pads. . . Annual Maintenance: Perform the following tests annually to confirm that the diagnostics are functioning properly and to verify the integrity of the case. Check the Integrity of the electrodes and circuitry . . . Check the integrity of the service indicator and circuitry . . ."

The facility failed to review the AED's operation and service manual and establish an appropriate maintenance program in accordance with the manual for the AED.

Based on observation, review of policy and procedure, and staff interview, the Critical Access Hospital (CAH) failed to store drugs and biologicals in a secure manner to prevent access by unauthorized personnel in 3 of 4 medication storage areas (Emergency Room [ER], Acute/Swing Bed/Intensive Care Unit [ICU] medication room, and nurses' station). Failure of the CAH to adequately secure and restrict access of drugs and biologicals created an opportunity for unsafe and unauthorized use of medications.

Findings include:

Review of the policy Nursing unit Inspection Policy" occurred on 01/15/15. This policy, revised April 2012, stated, ". . . POLICY: To make monthly inspections of all nursing units/drug storage areas to insure the proper use, storage, security and handling of pharmaceuticals . . . SECURITY: The inspection of each unit includes all areas that medications are stored. The inspector will insure that all security measures are in place appropriate for the medications and unit. . . ."

- Observation of the Main ER with an administrative nurse (#5) occurred on 01/13/15 at 4:00 p.m. and showed a crash cart, located by the exam table, locked with a yellow plastic break away lock. The crash cart contained various medications used in life-threatening situations. The back of the crash cart contained a clear plastic box, visible and easily accessible to anyone in the ER, with additional yellow plastic locks used as replacements for the lock. The staff member (#5) stated staff do not log when the cart is accessed and the yellow plastic lock changed, and also indicated housekeeping and maintenance staff know the key pad code and could enter the ER without supervision.

- Observation on 01/14/15 at 10:20 a.m. showed a small open plastic file box on top of the nurses' desk counter and accessible to staff, patients, and visitors. The box, labeled "Pharmacy," contained a dose of potassium chloride suspension and a bottle of nitroglycerin tablets. During the observation, an administrative staff member (#7) indicated nursing staff placed items and medications in the box for return to pharmacy.

- Observation of the ICU and Acute/Swing Bed medication room with an administrative nurse (#6) occurred on 01/14/15 at 11:00 a.m. The medication room had a key pad for access. The nurse (#6) indicated housekeeping and maintenance staff knew the code and could enter the room without supervision. The room contained an unlocked refrigerator containing a small black box secured with a yellow plastic break away lock. The box contained medication vials used for respiratory emergencies including propofol (hypnotic/amnesic) and other muscle relaxants and anesthetics. An unlocked cupboard contained another black box secured with a yellow plastic break away lock. This box contained emergency latex allergy medication vials including diphenhydramine (antihistamine), ephedrine (stimulant), and lidocaine (analgesic). An unlocked drawer contained replacement yellow plastic locks. The nurse (#6) indicated staff do not log when each box is accessed and the yellow plastic lock changed.

Based on review of infection control reports, logs, and meeting minutes, and staff interview, the Critical Access Hospital (CAH) failed to implement a system to identify, report, investigate, and control infections and communicable diseases for outpatients of the CAH for the past 6 of 6 months (July 2014 through December 2014) reviewed. Failure to identify and address incidents of infections among all patients and personnel has the potential for infections to go unreported, spread, or reoccur; affecting the health of all patients, personnel, and visitors of the CAH.

Findings include:

Reviewed on 01/14/15, the infection control records lacked evidence the CAH identified and recognized both nosocomial (hospital acquired) and community-acquired infections of outpatients receiving outpatient rehabilitation in physical therapy, occupational therapy, cardiac rehabilitation, and respiratory therapy. The infection reports/logs from July 2014 through December 2014 failed to include information and documentation of all outpatients with known or suspected cases of infections and/or communicable diseases.

During an interview on the morning of 01/15/15, an administrative staff member (#4) stated the facility does not receive or request infection control information from all outpatients, including outpatient rehabilitation patients and confirmed the CAH did not formally document and include all outpatients in infection control surveillance.

Failure to document all incidents of infection and communicable disease, perform surveillance among all outpatients of the CAH limited the staffs' ability to identify, monitor, track, control, and prevent infections.