HospitalInspections.org

Based on observation and interview the facility failed to (1) remove outdated drugs and supplies from stock in 2 of 2 areas and (2) failed to date insulin when opened on 1 medical-surgical unit.

The findings include:

1. Observation of drugs in the pharmacy on 3/5/12 at 10:10 a.m. revealed that there was one vial of Amidate etomidate injection 20 mg (2mg/ml) lot # 87-582-DK that expired on 3/1/12.

Interview with the Registered Pharmacist on 3/5/12 at 10:20am revealed that Amidate Etomidate injection was on back order for months and that he was holding the medication for emergencies. The pharmacist stated that he went to the emergency room twice a day to check on narcotics and that he checked the floor daily for outdated drugs.

2. Observation of the medication room on the medical-surgical unit on 3/5/12 at 10:45 a.m. revealed that there were expired insulins and biologicals in the refrigerator as followed:

In the refrigerator, there was a bottle of Pneumococcal vaccine polyvalent pneumovax 23 opened on 7/28/11 at 1445 that expired on 2/28/12. A bottle of gentle laxative tabs opened on 4/16/10 lot # 89M008U that expired on 1/12. This medication was in the cabinet above the sink in the medication room.

Lantus insulin 100 units/ml Lot # 1A0174 with an expiration date of 6/2012 was not dated when opened. There was less than half of the insulin remaining in the bottle.

Lantus insulin 100 units/ml Lot # OF023A with expiration 1/2012 was not dated when opened. Lantus Insulin 100u/ml Lot # YZF0182 was not dated when opened.
Novolin R Lot #YZF0460 opened on 8/23/11 was still available for use.

Interview with the Nurse Manager on 3/5/12 at 10:45a.m. revealed that they did not use the medications that much. She stated that pharmacy normally checked them but they also checked the medications; that the medications were checked on the first and fifteeth of each month. During this interview, the Nurse Manager discarded the medications in the garbage.

3. Observation of Room #1 Critical Care Room in the Emergency Room on 3/5/12 at 11:00 a.m. revealed that D5W 1000ml NDC # 04097922-09 expired on October 1, 2011.

Interview with the Nurse Manager of the Emergency Room on 3/5/12 at 11:15a.m. revealed that she did not realized that the intravenous fluids were expired. She stated that pharmacy was the one that changed out stock; that pharmacy checked stock daily and checked for expirations monthly.

Review of the policy and procedure for monthly nursing station inspection revealed that the Pharmacist-in-Charge will make monthly inspection of the nursing station, Emergency Room, Operating Room, Radiology, and other locations where drugs stored. During monthly nursing station inspection, the pharmacist was to look for unauthorized items, outdated items, label conditions, storage location, refrigerated items and crash carts. In conjunction with monthly inspection, the pharmacist will check the pharmacy stock for expired medications.