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Based on observations, staff interview and policy review, the facility failed to ensure that supplies available for use in the emergency room were marked with open dates, supplies were not expired, and sterile packages were not compromised. Findings include:


On 5/8/12 at 11:30 a.m., a tour of the emergency room department was completed with the nursing director. The following patient supplies were readily available for patient use lacked an open date or expiration date.
-3 bottles of Hydrogen peroxide;
-4 bottles of Betadine solution;
-Aquasonic ultra sound gel;
-Nu-prep ultra sound gel;
-7 vacutainers with the expiration date of 12/11; and
-4 sterile packages of Yankauer tips were open and exposed creating the patient equipment not to be sterile. The package stated if the package is open the item is not sterile;

On 5/8/12 at 11:30 a.m., during the tour of the emergency room the nursing director stated that all items which are opened should have an open date on the bottle. The nursing director stated that the supplies are checked monthly by the staff of the emergency room department. The sterile supplies should not be readily available for use if the package was compromise.

Policy review:
"Betadine bottles shall be dated when opened and discarded after 6 months. Any outdated non-pharmaceutical stock will immediately be pulled from the working inventory ..."

Based on observation and staff interview, the facility failed to ensure that a nitrogen cylinder in the supply room in the emergency room department was stored appropriately. Findings include:


On 5/8/12 at 11:30 a.m., a tour of the supply room was completed with the nursing director. The surveyor observed a full cylinder of nitrogen leaning against a supply shelf. The canister was unsecured. At this time, the nursing director stated she was not aware that the canister needed to be secured.

NFPA 99 Health Care Facilities, 1999 Edition, and Sections:
8-3.1.1 Cylinders and containers shall comply with 4-3.1.1.1(a).
4-3.1.1.1 Cylinder and Container Management. Cylinders in service and in storage shall be individually secured and located to prevent falling or being knocked over.

Based on observations, and staff interviews, it was determined that the Critical Access Hospital (CAH) failed to ensure patient privacy while patients were treated in the emergency room. The findings included:

On 5/7/12 at 1:15 p.m., the surveyor observed the emergency room department with the nursing director. During the tour, the surveyor observed a patient #3 being treated in emergency room number 2. The privacy curtain was not pulled and there were visitors walking through the hall. The patient was being asked by the nurse on staff medical questions which could be heard in the hallway.

Further into the tour, the surveyor observed another patient sleeping in room 4 with the door open.

A patient #4 was on the examination table in room 5 with the door open. A nurse was asking medical questions to the patient and administering medications to the patient. There were visitors observed to pass by these rooms.

On 5/7/12 at 2:10 p.m., another unidentified patient was observed in room 2 , the door was open and the privacy curtain was not pulled. The staff nurse was interviewing the patient regarding his/her medical history and medical concerns. The nurse proceeded to take vitals and then escort the patient past the other rooms, which contained patients, to the triage room. In the triage room, the patient was asked multiple questions with the door open. The triage room was right next to the waiting room which was occupied by people.

On 5/7/12 at 2:00 p.m., the emergency room manager stated that the privacy curtain should be pulled or the door should be shut if a patient was in a room.

On 5/8/12 at 11:30 a.m., a tour of the emergency room was completed with the nursing director. A tour by elementary children was in progress at this time. The elementary children were observed to enter the emergency room, stand, lean and cough next to the uncovered clean linen cart. The elementary children were escorted past emergency room 2 who was occupied by patient #1. The elderly patient was just transferred to the CAH by an ambulance. The privacy curtain was not pulled. During the observation, the elementary children and teacher were looking into the room. The surveyor asked the nursing director to pull the privacy curtain. The nursing director pulled the privacy curtain. Another nurse entered the room, opened the privacy curtain and started to ask medical questions and then left the room. The privacy curtain was left open. The patient's husband was in the room and was calming his wife down. Again, the nursing director pulled the privacy curtain while the second group of elementary children passed the room. At this time, an x-ray machine was brought into the room, the privacy curtain was opened and left opened even after x-rays were taken and the machine was removed from the room. The privacy of the patient was not provided. This observation ended at 12:00 p.m.

On 5/8/12 at 2:00 p.m., the surveyor asked the nursing director what information was provided to patients regarding protecting their privacy. The nursing director stated there were pamphlets in the waiting room, but nothing was provided to the patient. The nursing director stated that the privacy of all patients in the emergency room should be protected and that employees were trained during orientation. Upon review of the emergency department admission packet, there was not any information regarding protection of personal privacy in the packet.

Based on observation, staff interview, and policy review, the facility failed to ensure that clean linen used in the emergency room was protected at all times. Findings include:

On 5/7/12 at 1:45 p.m., and on 5/8/12 at 11:30 a.m., two clean linen carts were observed not to be covered. The linen carts were stored in the hall of the emergency room. There were multiple staff and visitors observed to walk by the clean linen carts. On 5/8/12 at 11:10 a.m., the surveyor observed a tour of elementary school children in the emergency room. Some of the children were leaning against the clean linen cart, touching patient linens, and coughing.

On 5/8/12 at 1:30 a.m., the nursing director stated that the linen carts should be covered at all times.

According to policy review "Clean linen: ....D. Each department's clean linen will be stored in a clean, dry enclosed area that is accessible to patient care staff and out of the main traffic flow."

5/23/12 at 3:45 p.m. per phone call with Cathy wolfe, VP Nursing Services, the results of monitoring will be reorted to the June 14, 2011.