HospitalInspections.org

Based on observation, review of recommendations by the Institute for Safe Medication Practices (ISMP), policy review, and interviews, the facility failed to store drugs safely and securely for one of two inpatient units.

The findings included:

Observations of the facility's Medical-Surgical/Telemetry Unit on July 15, 2014, at 2:15 p.m., revealed an unlocked refrigerator, used for medication storage, in the nurses' station. Further observation of the nurses' station revealed there were no doors or other closures/barriers between the refrigerator and the public hallway, which passed the nurses' station. Further observation revealed the refrigerator was approximately 8-10 feet from, and in direct line of sight of the hallway.

Observations of the medication refrigerator on July 15, 2014, at 2:15 p.m., revealed an unlocked plastic box, labled "Intubation Box", with the following drugs inside:
1. Three 10 milligrams (mg) vials of Vecuronium Bromide (an injectible Neuromuscular Blocking Agent/paralytic drug, which causes muscle paralysis).
2. Two 10 milliliters (ml) vials of Succinylcholine (an injectable neuromuscular blocking agent).
3. Four 10 ml vials of Rocuronium Bromide (an injectable neuromuscular blocking agent).
4. Two 10 ml vials of Etomidate (an injectable anesthesia/sedative drug used in the induction of anesthesia).

Further observations of the refrigerator revealed a second unlocked plastic box which contained:
1. One 10 ml multi-dose vial of Levemir (insulin, given by injection, used to treat elevated blood sugar).
2. One 10 ml multi-dose vial of Lantus (a long acting type of insulin).
3. One 3 ml multi-dose vial of Humulin R (a type of insulin)
4. Ten 5 ml single dose vials of Infuvite (an injectable multi-vitamin)
5. Ten 5 ml single dose vials of Diltiazem (an injectable drug which relaxes the muscles of the heart and blood vessels)
6. Fourteen 20 ml single dose vials of Famotidine (an injectible drug used to reduce stomach acid).

Further observation of the medication refrigerator revealed a clear plastic locking drawer attached to a shelf rack inside the refrigerator. The drawer contained fourteen 2 ml single dose vials of Lorazepam (an injectable schedule IV anti-anxiety medication). The small shelf and locked box were easily removed from the refrigerator. When pulled by the surveyor, the shelf and locked box easily slid loose from the refrigerator.

Review of ISMP recommendations regarding the safe storage of neuromuscular blocking agents, dated September 22, 2005, revealed, "...Neuromuscular blocking agents are considered high-alert drugs because misuse can lead to catastrophic injuries or death...When possible, dispense neuromuscular blocking agents from the pharmacy as prescribed for patients...Limit Access...Allow floor stock of these agents only in the OR (operating room), ED (emergency department), and critical care units where patients can be properly ventilated and monitored...Segregate storage. When these agents must be available as floor stock, have pharmacy assemble the vials in a sealed box with warnings affixed as noted below. Sequester the boxes in both refrigerated and non-refrigerated locations..."

Review of the facility's policy Inventory Control-Security of Medication Storage Areas, number IV-H, revised January 2010, revealed, "...All medication storage areas shall be locked or otherwise secured in such a way as to prevent access to medications by unauthorized persons...".

Interview with the Chief Nursing Officer on July 15, 2014, at 2:18 p.m., in the nursing station, confirmed the medication refrigerator was unlocked and the neuromuscular blocking agents were not in a sealed box or segregated from other medications in the refrigerator.

Interview with the facility's Pharmacy Director (PD) on July 16, 2014, at 9:30 a.m., in the pharmacy, confirmed the medication refrigerator in the Medical-Surgical/Telemetry Unit's nurse's station was not locked. Further interview confirmed the neuromuscular blocking agents stored in the refrigerator were not in a sealed box or segregated from other medications in the refrigerator.

Based on observation, policy review, and interviews, the facility failed to lock schedule IV drugs (medications with a limited potential for abuse) within a secure area for one of two inpatient units.

The findings included:

Observations of the facility's Medical-Surgical/Telemetry Unit on July 15, 2014, at 2:15 p.m., revealed an unlocked refrigerator, used for medication storage, in the nurses' station. Further observation of the nurses' station revealed there were no doors or other closures/barriers between the refrigerator and the public hallway, which passed the nurses' station. Further observation revealed the refrigerator was approximately 8-10 feet from, and in direct line of sight of the hallway.

Observation of the medication refrigerator on July 15, 2014, at 2:15 p.m., revealed a clear plastic locking drawer attached to a shelf rack inside the refrigerator. The drawer contained fourteen 2 milliliters (ml) single dose vials of Lorazepam (an injectable schedule IV anti-anxiety medication). The small shelf was not attached to the refrigerator, and the shelf with the attached locked box were easily removed from the refrigerator.

Review of the facility's policy Inventory Control-Security of Medication Storage Areas, number IV-H, revised January 2010, revealed, "...All medication storage areas shall be locked or otherwise secured in such a way as to prevent access to medications by unauthorized persons...".

Interview with the Chief Nursing Officer on July 15, 2014, at 2:18 p.m., in the nursing station, confirmed the medication refrigerator was unlocked.

Interview with the facility's Pharmacy Director (PD) on July 16, 2014, at 9:30 a.m., in the pharmacy, confirmed the medication refrigerator in the Medical-Surgical/Telemetry Unit's nurse's station was not locked.

Based on observations and interviews, the facility failed to maintain the facility and equipment in a sanitary manner and without damage for one of one dietary department, one of two operating rooms, and two of two inpatient units.

The findings included:

Observation of the kitchen on July 14, 2014, at 12:30 p.m., revealed the ceiling of walk-in refrigerator #3 had a large amount of rust, with two small (1-2 centimeter) holes penetrating the roof of the refrigerator.

Interview with the Dietary Manager (DM) on July 2014, at 12:30 p.m., in refrigerator #3, confirmed there were two small holes rusted through the ceiling of the refrigerator.

Observation of Operating Room (OR) #2 on July 2014, at 2:15 p.m., revealed an anesthesia supply cart with a large amount of rust on the outside of the cart. Further observations of the cart revealed the drawers were difficult to open.

Interview with the Certified Registered Nurse Anesthesist #1, on July 2014, at 2:15 p.m., in OR #2, confirmed the anesthesia supply cart was rusty and the drawers were hard to open.

Observation of room 101 on July 15, 2014, at 1:25 a.m., revealed the crank handles (for opening the window) had come loose from the window and the openings had been filled with a paper towel.

Interview with the Quality Manager (QM) on July 15, 2014, at 1:25 p.m., in room 101, confirmed the two holes in the window frame had been filled with paper towels.

Observation of a Passive Air Vent at the end of the 100 hall, on July 14, 2014, at 1:30 p.m., revealed the vent had a large amount of dust and lint inside the vent.

Interview with the QM on July 14, 2014, at 1:30 p.m., in the 100 hallway, confirmed the vent had a large amount of lint and dust inside.

Observation of room 109 on July 14, 2014, at 1:32 p.m., revealed the air conditioning vent had a large amount of rust, dust, and debris on and inside the vent.

Interview with the QM on July 14, 2014, at 1:32 p.m., in room 109, confirmed the air conditioning vent had a large amount of rust, dust, and debris, on and inside the vent.

Observation of room 110 on July 14, 2014, at 1:40 p.m., revealed a floor fan with a large amount of dust and lint build up on the blades and vents.

Interview with the QM on July 14, 2014, at 1:40 p.m., in room 110, confirmed the floor fan had a large amount of dust and lint on the blades and vents.

Observation of room 211 on July 14, 2014, at 1:44 p.m., revealed the air conditioning vent had a large amount of dust and debris inside the vent.

Interview with the Chief Nursing Officer (CNO) on July 14, 2014, at 1:44 p.m., in room 211, confirmed the air conditioning vent had a large amount of dust and debris inside the vent.

Observation of the Patient Nutrition Room on July 14, 2014, at 2:05 p.m., revealed the microwave oven had a large amount of dried food debris and spillage on the inside of the oven.

Interview with the CNO on July 14, 2014, at 2:05 p.m., in the Patient Nutrition Room, confirmed the microwave oven had a large amount of dried food debris and spillage on the inside of the oven. Further interview confirmed the oven must be cleaned immediately when dirty.

Based on observations, review of Centers for Disease Control and Prevention (CDC) guidelines, and interviews, the facility failed to follow infection prevention standards for cleaning blood spills for one of two inpatient units.

The findings included:

Observation of patient room number 110 on July 15, 2014, at 1:40 p.m., revealed one dimed sized spot of dried blood on the outside of the sharps container attached to the wall.

Observation of patient room number 111 on July 15, 2014, at 1:43 p.m., revealed three small (pea sized) spots of dried blood on the outside of the sharps container attached to the wall.

Observation of patient room number 113 on July 15, 2014, at 1:45 p.m., revealed a dime sized spot of dried blood on the outside of the sharps container attached to the wall.

Review of the Centers for Disease Control and Prevention (CDC) guidelines revealed, "...Promptly clean and decontaminate any location with spills of blood and other potentially infectious materials...".

Interview with the Chief Nursing Officer (CNO) and the Quality Manager (QM) on July 15, 2014, at 1:46 p.m., in the medical surgical hallway, confirmed there were spots of dried blood on the outside of the sharps containers in rooms 110, 111, and 113. Further interview confirmed the facility's practice was blood spills must be cleaned immediately.