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Based on review of facility policy, findings during tours of the facility, and staff interview, it was determined that the facility failed to ensure that expired medications, biologicals and supplies were not available for patient use.

Findings were:

Facility policy entitled, Unusable and Outdated Drugs, not dated, stipulated that all drug storage areas of the hospital be inspected for outdated, contaminated, and improperly stored drugs, and that the pharmacy staff conducting the inspection remove all these types of drugs from the area(s) found to a designated expired drug area.

During a tour of the facility's Emergency Department (ED) with the ED Manager (employee#21) at 9:45 a.m. on 5/16/2012, the following medications and biologicals were observed to be expired and available for patient use:
1. Adult Crash Cart (cart with medications and supplies for use during medical emergencies):
? Verapamil (to treat high blood pressure, irregular heart beats and chest pain) 2.5 milligrams (mg- unit of measure)/milliliter (ml- unit of volume). Two (2) vials expired 1 Jan 2012.
2. Pediatric Crash Cart:
? Lidocaine 2% syringe- 100 mg/5 ml. One (1) syringe expired 1 April 2012.
? D10W (10% dextrose in a water-based solution)- Intravenous fluid (IVF- solution administered in the vein for hydration and/or administration of medications)- Two (2) 500 ml bags expired 1 Jan 2011;
? D5W (5% dextrose in a water-based solution)- IVF- One (1) 500 ml bag expired August 2010; and
? D5 and 1/2 NS (5% dextrose in 0.45% saline-based solution)- IVF- Two (2) bags expired 1 March 2011.

2. Inspection of the ED's Pediatric Crash Cart revealed that supplies were divided into color-coordinated supply kits and drawers, and that the supplies were provided in sizes appropriate to weights designated by each kit. Each kit was further divided into sets labeled for use in starting IV's (IV Delivery Module) and for maintaining/restoring a patient's airway (Intubation Module). The IV Modules contained IV catheters/needles, a skin preparation kit, and an IV tubing extension set. The Intubation Modules contained equipment to insert tubes into a patient's airway, the tubes to be inserted, suction catheters and tubing for both the airway and stomach, a syringe, lubricating jelly (to ease insertion of the tubes), adhesive tape, and gauze. During the Crash Cart's inspection, the following supplies were observed to be expired but available for patient use:
? Pink/Red kits (for newborns)- IV Delivery Modules- One (1) expired in May 2011; Intubation Modules- 1 expired May 2011;
? Purple kits (for 10 - 11 kilogram [kg- unit of weight] patients)- IV Delivery Modules- one expired October 2011, and 1 Intubation Module expired May 2011;
? Yellow kits (for 12 - 14 kg patients)- IV Delivery Modules- one expired August 2010, and one Intubation Module expired July 2011;
? White Kits (for 15 - 18 kg patients)- IV Delivery Modules- one expired October 2010, and one Intubation Module expired July 2011;
? Blue kits (for 19 - 23 kg patients)- IV Delivery Modules- one expired August 2010, and one Intubation Module expired July 2011;
? Orange kits (for 24 - 29 kg patients)- IV Delivery Modules- one expired October 2010, and one Intubation Module expired August 2011; and
? Green kits (for 30 - 36 kg patients)- IV Delivery Modules- one expired October 2011, and one Intubation Module expired July 2011;