HospitalInspections.org

The Critical Access Hospital (CAH) reported a census of 14 acute and swing bed patients. Based on observation, document review, and staff interview, the CAH failed to follow the manufacturer ' s guidelines for single use parenteral medications; failed to develop and implement 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 manufacturer ' s information sheet for propofol 1% injectable emulsion reviewed on 8/12/13 at 3:30pm directed " ...a single-use parenteral product ...not an antimicrobially preserved product ... "

- The CAH ' s policy titled " Labeling for outdates and automatic discarding of meds " reviewed on 8/12/13 at 2:20pm directed " ...All vials that do not contain preservatives shall be discarded after the initial dose has been obtained ... "

- Observation in the surgical suite called " major " on 8/12/13 at 1:25pm 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. An unlabeled syringe, which contained 30cc of a white liquid
2. A syringe labeled " Fentanyl " (used to help control pain) which contained 1.5cc of a clear liquid, no name, date, or time was on the label
3. A syringe labeled " glycopyrrolate " (used to decrease acid in the stomach) which contained 2cc of a clear liquid, no name, date, or time was on the label
4. An open vial with a label " Lidocaine 1% " (used to help control pain), no name, date, or time was on the label
5. An unlocked shoebox sized box that was not in use and was unmonitored labeled " OR " contained an open vial with a label " propofol 1% single patient use " (used for sedation) ; 4 vials of Fentanyl 500mcg/10cc (used to help control pain) ; 4 vials of Fentanyl 250mcg/5cc; 8 vials of Midazolam (used to cause drowsiness) 5mg/cc; 10 ampoules of Sufenta 50mcg/cc (used to help control pain).

- Observation in the surgical suite called " minor " on 8/12/13 at 3:45pm revealed an unlocked cabinet that was not in use and was unmonitored. The cabinet contained 20 vials of propofol (used for sedation) 20 mg/20cc; 6 vials containing 100 cc of propofol 10mg/cc; 9 vials containing 50cc of propofol 10mg/cc; all vials were marked " single use " . A small, unlocked refrigerator which was not in use and unmonitored contained 2 vials succinylcholine (a muscle relaxer) 200mg/cc; 2 vials rocuronium bromide (a muscle relaxer) 100mg/10cc.

- Staff A, director of nursing, interviewed on 8/12/13 at 4:10pm acknowledged propofol labeled " single use " is used for more than one patient, and acknowledged medications used in the surgery area were not kept locked when not in use and unmonitored.

- Staff D, pharmacist, interviewed on 8/14/13 at 9:50am acknowledged propofol labeled " single use " is used for more than one patient, and acknowledged medications used in the surgery area were not kept locked when not in use and unmonitored.

The Critical Access Hospital (CAH) reported a census of 14 acute and swing bed patients. Based on observation, document review, and staff interview, the CAH failed to follow its policy to perform and document a pre-anesthesia assessment for six of six patients requiring a pre-anesthesia evaluation (patient # ' s 11, 12, 13, 14, 15, and 31).

Findings include:

- The CAH ' s policy titled " Anesthesia Services " revised 2/2010 and reviewed on 8/12/13 at 3:00pm directed " ...CRNA scope of practice includes, but not limited to the following ...performing and documenting a pre-anesthetic assessment and evaluation of the patient ... "

- Observation of patient #31on 8/12/13 at 9:30am revealed certified registered nurse anesthetist (CRNA) entered the patient ' room and reviewed current medications with patient. The CRNA failed to perform a pre-anesthetic health assessment and evaluation of the patient prior to surgery.

- Patient #11 ' s medical record reviewed on 8/14/13 revealed an admission date of 7/23/13 for surgical procedure of subtotal thyroidectomy (a partial removal of the thyroid). The record lacked a pre-anesthesia evaluation.

- Patient #12 ' s medical record reviewed on 8/14/13 revealed an admission date of 7/30/13 for surgical procedure of cataract removal (eye surgery). The record lacked a pre-anesthesia evaluation.

- Patient #13 ' s medical record reviewed on 8/14/13 revealed an admission date of 5/3/13 for surgical procedure of peg tube insertion (surgically inserting a feeding tube through the skin). The record lacked a pre-anesthesia evaluation.

- Patient #14 ' s medical record reviewed on 8/14/13 revealed an admission date of 8/5/13 for surgical procedure of colonoscopy (an examination of the colon). The record lacked a pre-anesthesia evaluation.

- Patient #15 ' s medical record reviewed on 8/14/13 revealed an admission date of 5/13/13 for surgical procedure of ventral herniorrhaphy (repair of a hernia in the abdomen). The record lacked a pre-anesthesia evaluation.

- Patient #31 ' s medical record reviewed on 8/14/13 revealed an admission date of 8/12/13 for surgical procedure of upper endoscopy (an examination of the esophagus and stomach area). The record lacked a pre-anesthesia evaluation.

- Staff A, director of nursing, interviewed on 8/13/13 at 4:30pm acknowledged the CAH failed to perform and document a pre-anesthesia assessment for the patients.