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Based on observation, interview and record review, the hospital failed to ensure life saving equipment which included airway equipment was not expired.

Findings include:

On 5/16/17, at 8:30 a.m. during an emergency room tour observation an airway cart was noted in the emergency room supplies. The airway cart was kept because anesthesia thought it was important to have in the emergency room. The airway cart contained two boxed pediatric 5.5 cuffless tracheostomies that had expired 8/2016 by the manufacturer. Two boxed adult 7.6 cuffed tracheostomies that were had expired 12/2016 by the manufacturer.

The emergency department coordinator (EDC) and chief nursing officer (CNO) were not aware of the expired tracheotomies [manufacturer date of expiration], the supplies were restocked by the EDC, other nurses or by aides that were working in the CAH [Critical Access Hospital]. There was not a process for checking the outdated supplies in the airway cart.




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The airway cart in the operating room had expired airways in the drawer.

A tour of the surgical suite was conducted on 5/17/17, at 1:00 p.m. with certified registered nurse anesthetist (CRNA)-A. The surgery suite had one operating room. In the operating room was an airway cart that housed prepacked airways and each airway had an expiration date. The endotracheal tubes are used as a catheter that are inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure adequate exchange of oxygen and carbon dioxide.

The following airways had expired:
- Endotracheal tube, size 3.0, expired 1/15, one airway
- Endotracheal tube, size 3.5, expired 12/16, one airway
- Endotracheal tube, size 4.0, expired 7/14, two airways
- Endotracheal tube, size 4.5, expired 5/15, two airways
- Endotracheal tube, size 5.0, expired 11/16, one airway
- Endotracheal tube, size 5.0, expired 6/15, two airways
- Endotracheal tube, size 6.0, expired 4/15, four airways
- Endotracheal tube, size 6.0, expired 6/11, one airway
- Endotracheal tube, size 7.5, expired, 5/10, three airways
- Endotracheal tube, size 7.5, expired 10/09, one airway
- Endotracheal tube, size 7.5, expired 8/14, one airway

CRNA-A was interviewed during the airway cart inspection, and the CRNA agreed that the dates on the endotracheal tubes listed above had expired as listed above. CRNA indicated that he checked the airway cart once a month. He further explained that the hospital no longer does surgery on children. In addition, the CRNA-A stated that he uses size 7.0 for adult females and size 8.0 for adult male patients. The identified outdated endotracheal tubes were immediately discarded by CRNA-A.

The facility's policy, Dating of Sterilized Supplies, reviewed on 9/14/16, indicated that "Supplies sterilized by manufacturers will be outdated as specified on the package, unless events, handling or storage conditions are identified which may have compromised sterility.

Based on the Life Safety Code (LSC) survey. A Medicare-participating Critical Access Hospital (CAH), including all component parts or facilities of the CAH, must comply with the applicable LSC requirements.

Please refer to the life safety code deficiencies cited at: K0131, K0321, K0325, K0900, for additional information.