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The Critical Access Hospital reported a census of one swing bed patient and no acute care patients. Based on observations and interview the facility failed to ensure Emergency room equipment, supplies and medications are available in accordance with accepted standards of practice.

Findings include:

- Observations made on 4/26/10 at 9:00am in the Emergency room revealed:
1.) Two - Whin 90" Huber Needles with an expiration date of 3/10.
2.) Four - Insyte Auto guard 22 gauge 1 inch needles with an expiration date of 11/08.
3.) Two- Angio-cath 14 gauge x 5.25, one with an expiration date of of 10/06 and one with an expiration date of 3/09.
4.) One- Porta-a-Cath kit with one- 30 millileter (ml) Heparin Flush syringe with an expiration date of 4/06, one- 30 ml bottle of Sodium Chloride with an expiration date of 11/08, and three- Povidone-Iodine swab sticks with an expiration date of 2/09.
5.) Seven- Opthalmalic Bovie with an expiration date of 12/06.
6.) One - 3.5 gram tube of Neomyacin and Polymyxin B opthalimic ointment with an expiration date of 1/10.
7.) Three - Kendall Xeroform 5x9 inch Fine mesh dressing with an expiration date of 2/10.
8.) Two - BD E-Z Scrub 408 brush with sponge with an expiration date of 1/10.
9.) One - 30ml open bottle of 2% Lidocaine lacked a date of when opened.

Interview with Staff C on 4/26/10 at 9:00am confirmed the equipment, supplies, and medications are outdated and it is the nurse's responsibility to check for outdates.

The Critical Access Hospital (CAH) reported a census of one swing bed patient and no acute care patients. Based on observation and interview the facility failed to develop a system to monitor for outdated drugs, supplies and biologicals in the Surgical Suite.

Findings include:

- Observation of an Esophogeal procedure on 4/26/10 at 9:30am revealed a bottle of Cetacain spray with an expiration date of 3/10. An interview at this time with Staff B confirmed the usage of the expired drug on this patient as well as two other patients, one on 4/12/10 and one 4/26/10.

- Observation of the Surgical suite drug box on 4/26/10 revealed the following:
1.) One bottle of Aminophyllin with an expiration date of 2/10.
2.) One bottle of Epinephrine 1:10000, 1milligram (mg)/10ml with an expiration date of 3/10.
3.) One bottle of Polyethelin Glyco with an expiration date of 3/10.
4.) One - 4 fluid ounce bottle of 3M Remover lotion with an expiration date of 2/08.
5.) Thirty Six packages of Ti-Cron 2-0 Blue Braided Polyester Sutures with an expiration date of 9/09.
6.) Twelve packages of Dexon S 4-0 1.4 metric uncoated polyglycobic suture material with an expiration date of 1/10.
7.) Fourteen packages of EZ Scrub surgical scrub brush with 3% Chloroxylenol with an expiration date of 1/10.
8.) Five- Intubation Stylets with an expiration date of 11/09.

Interview with Staff B on 4/27/10 at 10:00am confirmed the outdates of the supplies, drugs and biologicals and confirmed they are responsible for checking for the outdates.

The Critical Access Hospital reported a census of one Swing bed patient and no acute care patients. Based on observations and interview the Critical Access Hospital failed to ensure all drugs, supplies and biologicals are properly stored, disposed of when outdated, and have a plan in place to check for outdates.

Findings include:

- Observation on 4/27/10 at 9:00am of the Central Sterile room revealed a fluid warmer housing two bottles of sterile water, one bottle of sodium cloride, both, without dates of when placed in the warmer or a date of when each must be pulled from the warmer. The fluid warmer also contained one intravenous bag of lactated ringers and one bag of normal saline both with a date of 02/08/2010 written on each bag.

Interview with staff B on 4/27/10 at 9:00am, confirmed this date is the date both bags become outdated.

The Critical Access Hospital reported a census of one swing bed patient and no acute care patients. Based on observation and interview the facility failed to evaluate the effectiveness of their infection control program.

Findings include:

- Observations made on 4/26/10 at 9:30am revealed a suction tube (Yaunker) connected to the suction cannister in the Emergency Room. The sterile suction tube package label contained printed instructions, "Sterile only if not open or damaged" on the outside of the single use package.

Interview on 4/26/10 with Staff B at 9:30am acknowledged the Yaunker suction tube needs to remain closed until ready to use.

- Observation made on 4/26/10 at 11:20am of Staff F entering the outpatient room. Staff F failed to wash hands or use hand gel prior to providing care to the outpatient. Staff F left the room and failed to wash hands or use hand gel after the care to the outpatient. Staff F proceeded to enter the swing bed patient's room. Contact Precaution signs posted on the door of the swing bed patient's room instructed staff to wash hands prior to entering, use gloves and wash hands after exiting the room. Staff F failed to follow these instructions.

- Observation made on 4/26/10 at 11:35am of Staff G entering the swing bed patients room with contact precautions posted on the door. Staff G failed to wash hands, use gloves or use hand gel prior to entering the patients room. Staff G touched the patient's sitting chair, the bedside table, the bed and then proceeded to walk out of the patient's room. Staff G failed to wash hands or use hand gel after leaving the patient's room.

Interview on 4/26/10 at 11:40am with staff C confirmed the staff failed to wash hands, use gloves, or use hand gel upon entering and leaving the room.

- Observation made on 4/27/10 at 9:00am revealed a suction tube (Yaunker) connected to the suction cannister in the Surgical Suite. The sterile suction tube package label contained printed instructions, "Sterile only if not open or damaged" on the outside of the single use package.

Interview on 4/27/10 at 9:00am with staff B acknowledged the Yaunker suction tube needs to remain closed until ready to use.

Based on observation, document review, and staff interview the Critical Access Hospital failed to assure recognized sanitary conditions in the food preparation area. The facility reported a census of one swing bed patient and no acute care patients.

Findings included:

- Policy provided on 4/27/10 at 11:45am directs "dishwashing machine temperatures are: Wash 130-150F and rinse 125-135F. Temperatures are checked biweekly and chemical content in rinse is checked biweekly using test strips." Staff E acknowledged no log is kept and she has no knowledge whether this task was completed as directed.

- Policy provided on 4/27/10 at 11:45am directs "A daily cleaning schedule is posted in the kitchen to insure adequate sanitation of all storage, work areas, and equipment." Observation on 4/27/10 at 11:30am revealed crumbs and dirty surface inside west cabinet. The posted schedule had a cleaning date of 4/1/10 for the west cabinet. Staff E acknowledged the cabinet could not have been cleaned on 4/1/10.

- Policy provided on 4/27/10 at 11:45am directs "Leftover food is covered, labeled and dated immediately after serving. Refrigerated food is used within 24 hours or frozen immediately." Observation on 4/27/10 at 11:30am revealed 2 leftover food containers dated 4/14, one labeled 4/18, one labeled 4/19, and one undated. Observation also revealed an open container of curdled buttermilk and five open juice containers with no date. Staff E confirmed these findings.

- Observation made on 4/27/10 at 11:30am revealed two trash cans in the food preparation area with no lids. Staff E confirmed trash cans should be covered.

- Observation made on 4/27/10 at 11:30am revealed chipped and rusted cabinets in the food preparation area. Staff E acknowledged the cabinets were non-cleanable surfaces.

- Observation made on 4/27/10 at 11:30am revealed grimy dirt on the paper towel holder above the sink in food preparation area. Staff E acknowledged the unclean surface.

- Observation made on 4/27/10 at 11:30am revealed a dirty fan pointed toward the food preparation area. Staff E acknowledged the unclean fan.

Based on record review and staff interview the Critical Access Hospital (CAH) failed to assure the medical staff accurately dated, timed, and signed orders for 19 of 42 records requiring signature, date, and time (record #'s 11, 14, 15, 21, 22, 23, 25, 26, 27, 28, 29, 31, 32, 35, 36, 38, 40, 41 and 42).

Findings included:

- On 4/28/10 at 3:30pm Staff A, C, and D acknowledged there is a problem with medical staff dating and timing signature on orders.

- Patient #21's medical record revealed 12 orders, written from 4/20/10 to 4/24/10 lacked a date and/or time.

- Patient #31's medical record revealed 5 orders, written from 11/24/09 to 11/25/09 lacked a date and/or time.

- Patient #42's medical record revealed 3 orders, written from 3/25/10 to 3/27/10 lacked a date and/or time.

- This deficient practice also affected patient #'s 11, 14, 15, 22, 23, 25, 26, 27, 28, 29, 32, 35, 36, 38, 40, and 41.