HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of 10 acute, obstetrics, and swing bed patients. Based on observation, document review, and staff interview, the CAH failed to follow their policies and procedures directing staff to label pre-drawn medications, and failed to develop and implement policies and procedures directing staff to secure drugs in accordance with accepted professional principles.

Findings include:

- The CAH ' s policy titled "Anesthesia Pre-Induction Safety Requirements" revised on 1/28/13 and reviewed on 9/17/13 at 2:20pm directed "...filled syringes will be properly labeled..."

- Observation in the surgical suite numbered "4" on 9/16/13 at 9:50am revealed an unlocked anesthesia cart that was not in use and was unmonitored. Located on top of the unlocked anesthesia cart were the following:

1. 2 vials robinul 0.2cc/1cc (used to reduce secretions).
2. 1 vial anectine 200mg/10cc (to help with anesthesia).
The unlocked anesthesia cart contained:
3. 1 unlabeled syringe, which contained 20cc of a white liquid
4. 2 syringes labeled "xylocaine 2%" (a local anesthetic), each contained 2cc's of clear liquid, no name, date, or time included on the label.
5. 10-20cc vials 1% propofol 10mg/cc (used for sedation)
6. 5-50cc vials 1% propofol 10mg/cc (used for sedation)
7. 1 vial metaprolol 1mg/5cc (helps control blood pressure)
8. 1 vials ketamine 500mg/cc (used for anesthesia)
9. 1 vial ketorolac 30mg/cc (used for pain)
10. 1 vial labetalol 100mg/20cc (helps control blood pressure)
11. 1 vial atropine 8mg/20cc (helps with life threatening situations)
12. 1 vial etomidate 20mg/10cc (used for anesthesia)

- Observation in the surgical area hallway on 9/17/13 at 7:20am-7:32am revealed an unlocked closet that was not in use and was unmonitored. The closet contained many medications for use in the surgical area.
Also included in the closet were four filled unlocked anesthesia trays.
Each anesthesia tray contained:
1. 1 vial epinephrine (helps with life threatening situations)
2. 3 vials lidocaine (a local anesthetic)
3. 2 vials labetalol 20cc (helps control blood pressure)
4. 2 vials naloxone 0.4mg (used to treat opioid overdose)
5. 3 vials ephedrine (to help with shortness of breath)
6. 1 vial furosemide 40mg (to help with fluid in the body)
7. 1 vial etomidate (used for anesthesia)
8. 1 vial hydralazine (to help with high blood pressure)
9. 1 vial 1 % phenylephrine (to help with low blood pressure)
10. 1 vial terbutaline (helps with breathing)
11. 6 vials oxytocin (can help with bleeding)
12. 1 vial atropine 20cc (helps with life threatening situations)
13. 1 vial robinul 20 cc (used to reduce secretions)
14. 5 vials ondansetron (used to help control nausea)
15. 4 vials metoclopramide (helps control heartburn)
16. 4 vials ranitidine (helps control heartburn)
17. 3 vials ketorolac 30 mg (used for pain)
18. 1 vial ketamine 500 mg (used for anesthesia)
19. 1 vial metoprolol 5mg (helps control blood pressure)
20. 2-50 cc vials propofol (used for anesthesia)
21. 9-20cc vials propofol (used for anesthesia)
22. 3 vials zemuron (used as muscle relaxant)
23. 1 vial atracurium (helps with anesthesia)
24. 3 vials vecuronium (used as a muscle relaxant)
25. 1 vial neostigmine (helps control urine retention)
26. 1 vial dexamethasone 10mg/cc (helps control inflammation)
27. 2 vials flumazenil (can help reverse anesthesia)
28. 1-50cc vial of lidocaine 2% (an anesthetic)

- Staff C, a Certified Registered Nurse Anesthetist, interviewed on 9/16/13 at 9:57am acknowledged the unlocked anesthesia belonged to them, they had prefilled the syringes, and the syringes did not include the name of the drug, date drawn, and time.

- Staff A, charge nurse of surgery, interviewed on 9/17/13 at 2:00pm acknowledged the medication closet in the surgery hallway is unlocked when not in use and unmonitored.

The Critical Access Hospital (CAH) reported a census of 10 acute, obstetrics, and swing bed patients. Based on observation, document review, and staff interview, the CAH failed to follow their policies and procedures directing staff to contain hair in the surgical area.

Findings include:

- The CAH's policy titled "O.R. Policy" reviewed on 9/17/13 at 12:30pm directed, " ...hair and beards must be contained ..."

- Staff E, Registered Nurse (RN) observed on 9/17/13 at 8:30am entered the surgical suite with a skull cap head covering which did not contain hair.

- Staff D Certified Registered Nurse Anesthetist (CRNA) observed on 9/17/13 at 8:30am entered the surgical suite with a skull cap head covering which did not contain hair.

- Staff F, surgeon, observed on 9/17/13 at 8:30am entered the surgical suite with a skull cap head covering which did not contain hair.

RN and Operating Room Manager Staff C, interviewed on 9/17/13 10:30am acknowledged the CAH failed to follow their policy to contain all hair.