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Based on observation, interview and record review, the facility failed to ensure expired medications and supplies were not available for immediate patient use in the emergency department and on the pediatric and neonatal intensive care patient units in the emergency crash cart.

Findings:

During a tour of the emergency department fast track area on 5/06/13 at 11:05 a.m. observation of the Brasloe pediatric crash cart, used in respiratory and cardiac emergency situations, showed the following:

1. The outside of drawer #1 showed a label with a date of 5/01/13 as the date of the first drug expiring in the drawer. Review of the tray inside of the drawer showed the pharmacy tray had 4 vials of Lasix 4 milliliters, a diuretic medication, each with an expiration date of 5/01/13 and 1 vial of Nipride 2 milliliters, a medication used to increase blood pressure, with an expiration date of 5/01/13.

The Emergency Department (ED) manager confirmed the medications were expired.

During an interview on 5/06/13 with the ED manager, she said there were a total of 5 crash carts in the ED and they are to be checked by the staff every shift.

2. Observation of the Brasloe pediatric crash cart located in examination room #4 on 5/01/13 at 11:10 a.m. showed the following:

Pink/Red-Drawer #2 - 1 pediatric intravenous (IV) delivery module kit for starting an IV with an expiration date of 12/2012.

White-Drawer #5 - 1 pediatric intubation, used to place a breathing tube in the wind pipe, module kit with an expiration date of 3/2013.

Blue-Drawer #6 - 1 pediatric intravenous (IV) delivery module kit for starting an IV with an expiration date of 2/2012.

Orange-Drawer #8 - 1 pediatric intubation module kit with an expiration date of 3/2013.

Green-Drawer #9 - 1 pediatric Medtronic defibrillator electrode package with an expiration date of 1/28/2012.

All were on the cart and available for immediate patient use. The chief nursing officer (CNO) and the ED nurse manager were both present and confirmed the items were expired.

3. During a tour and observation on 5/06/13 at 12:53 p.m. of the obstetric supply room, one (1) female sterile urinary catheterization kit was opened and available for immediate patient use. The charge nurse confirmed the kit was opened and should have been removed.

4. During the toured on the 3rd floor pediatric unit on 5/07/13 at 10:45 a.m., observation of the Brasloe (pediatric) crash cart located in hallway on 5/07/2013 at 10:45 a.m. showed the following:

Pink/Red-Drawer #2 - 1 pediatric IV delivery module kit for starting an IV with an expiration date of 10/2012.

Purple-Drawer #3 - 1 pediatric IV delivery module kit for starting an IV with an expiration date of 11/2012 and 1 pediatric intubation module kit with an expiration date of 1/2013.

Yellow-Drawer #4 - 1 pediatric intubation module kit with an expiration date of 3/2013.

White-Drawer #5 - 1 pediatric intubation module kit with an expiration date of 3/2013 and 1 trocar #20 French catheter, used for chest tube placement, with an expiration of 11/2012.

Blue-Drawer #6 - 1 pediatric intubation module kit with an expiration date of 3/2013 and 1 trocar #32 French catheter, used for chest tube placement, with an expiration of 11/2012.

Orange #7 - pediatric IV delivery module kit for starting an IV with an expiration date of 10/2012, 1 pediatric intubation module kit with an expiration date of 3/2013, 1 trocar #32 French catheter with an expiration of 11/2012, and 1 #28 French trocar catheter with an expiration date of 4/2013.

Green-Drawer #8 - pediatric IV delivery module kit for starting an IV with an expiration date of 5/2012, 1 pediatric intubation module kit with an expiration date of 3/2013, and 1 trocar #32 French catheter with an expiration of 12/2012.

Review of the pediatric crash cart check list log showed the cart as checked daily during the month of May 2013.

During an interview on 5/07/2013 at 11 a.m., the registered nurse (RN) director of the pediatric department said the cart was just checked yesterday. The CNO was present during this observation and confirmed the expired supplies. All items were on the cart and available for immediate patient use.

5. During a tour of the neonatal intensive care unit (NICU) on 5/07/13 at 11:10 a.m., the pediatric crash cart was found to have the following expired supplies available for immediate patient use:

3 arterial blood sample syringes with an expiration of 3/2013 and 1 Provent arterial blood sampling kit with an expiration of 2/2013.

During an interview on 5/07/2013 at 11:10 a.m., the RN said the crash cart was just rechecked yesterday for outdated supplies and medications.

During an interview on 5/09/13 at 10:45 a.m., the pharmacy director said the process for changing out the crash carts is as follows: the cart is brought to the pharmacy and the medications are removed, the cart is then taken to the central supply area and the supplies are checked and the cart is then returned to the pharmacy for the medication tray replacements and locked and it is then ready for use.

Review of the policy "Code Cart Monitoring and Maintenance", revised 2/2013, read, "All Code Carts shall be checked by the individual departments in which they are located....the first to expire cards shall be checked monthly to ensure that there are no expired items in the Code Cart in the event that the cart has not been used. It is the responsibility of the personnel assigned to complete this checklist and notify either Materials Management or Pharmacy of any expired/missing items."

Based on observation and interview, the facility failed to ensure 1 of 2 Caesarian section rooms, 1 of 4 cardiac catheterization labs, and 3 of 18 intensive care rooms were clean and sanitary.

Findings:

1. Observation on 5/07/13 at 2:20 p.m. of the cardiac catheterization lab Electro-physiology room (any of the 4 labs can be used for all procedures) found the following: an anesthesia cart with the top dusty and in need of cleaning, the top of the overhead light is dusty and in need of cleaning, and the top of cardiac monitoring screens are dusty and in need of cleaning. The registered nurse (RN) said the room was last used on 5/01/13. When asked when the rooms are terminally cleaned, the she said it is wiped down prior to use, but only the surfaces, and the tops of the lights and monitors would not be cleaned until after the procedure was completed. The chief nursing officer (CNO) and the cardiac catheter lab director were both present and confirmed the dusty findings.

During an interview on 5/07/13 at 2:45 p. m. the RN Quality nurse for the cardiac catheterization lab said she said currently monitors the areas for cleanliness, but does not document any of it.

2. During a tour of the 2 operating rooms in the obstetrics department used for Caesarian sections (C-sections), room #1 had dust on the top of the Pxyis machine and the top of the anesthesia drug cart was in need of cleaning.

During an interview on 5/06/13 at 3:10 p.m., staff confirmed the dust on top of the equipment and said the room was last used on 5/01/13. The CNO was present during the C-section room observations.

Review of the policy "High Dusting", dated as reviewed 11/15/12, read, "High dusting items in areas above normal hand shall....be done by EVS (environmental service) associates as an integral part of the cleaning process....The procedure includes the following items to be cleaned - wall mounted TV sets, tops of over-bed light fixtures, tops of examination light fixtures, and any other items that need to be dusted above normal hand reach.

During an interview on 5/08/13 at 3:30 p.m., the infection control officer said she or her assistant make environmental rounds in all areas of the hospital. She said she or her assistant were last in the labor and delivery area on 10/31/12 and in the cardiac catheterization area on 9/07/12 and 4/23/13 for environmental rounding.


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3. On 5/08/13 starting approximately at 9:30 a.m., tour of the Intensive Care Unit (ICU) accompanied by the nurse manager, the charge nurse and the director of Medical/Surgical/PCU (Progressive Care Unit), revealed the following:

In room 249, there was visible dust on top of the cardiopulmonary monitor. When the monitor was wiped with a finger, the dust easily came off.

In room 250, there was visible dried matter on the left frame of the bed near the head of bed site. There was also dried matter on the frame and wheelbase cover on the left side. The nurse manager touched the material and it was definitely dried onto the frame.

In room 252, there was visible dust on top of the ventilator being used by the patient. It was easily removed by a swipe of a hand.

In all incidences described above, the nurse manager confirmed the findings.