HospitalInspections.org

Based on observation and staff interviews, the hospital failed to properly discard expired patient care supplies in 2 of 5 departments, emergency and radiology. Findings include:

On 7/1/13 at 5:20 p.m., during the review of the emergency department the following expired supplies were observed by the surveyor:

-two bottles of Iodoform Packing Strip with expiration dates of 12/12.
-one bottle of Iodoform Packing Strip with an expiration date of 3/13.
-twenty-three packages of 4-0 Chromic Gut 27" sutures with an expiration date of 7/12.

During an interview with staff member F, RN, during the emergency department tour; "Nurses check for outdates monthly."

During an interview with staff member A, the DON, on 7/2/13 at 3:30 p.m., stated "We do not have a policy, just a form for checking monthly outdates of supplies."





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The surveyor observed 1 bottle of Mochaccino Smoothie flavored Redi Cat 2 with the manufacturer's expiration date of 9/2012 in the radiology department on 7/1/13 at 10:00 a.m. Staff member M stated the radiology staff look for outdates when they stock.

Based on record review and staff interview, the facility failed to ensure that 7 (#s 10, 16, 17, 19, 20, 24, and 25) of 17 potential organ donor families or significant others were contacted regarding possible organ donation. Findings include:

During the review of 17 expired patient records on 7/2/13 beginning at 1:00 p.m., the surveyor noted that the records of 7 of 17 patients and residents that had expired over the preceding 14 months did not include documentation of the contact with the organ procurement organization, and the decision that the patient/resident was or was not a candidate for donation.

During an interview with staff member A, the Director of Nursing, on 7/2/13 at 4:15 p.m., staff member A expressed surprise that the documentation was missing and stated that the organ procurement organization that the facility contracted with had changed ownership in the last year and there had not been a smooth transition to the new company.