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Based on observation, record review and interview, the hospital failed to ensure:
1. crash carts were prepared for use for one (Medical Surgical Unit) of two crash cart areas/units
2. temperature checks were completed for one (Medical Surgical Unit) of one blanket warmers

This failed practice has the likelihood to place patients at risk of delay in care and receiving care with the use of supplies or machinery not known to be functioning or effective to provide therapeutic benefit.

Review of policy titled "Nursing: Emergency Crash Carts" read in part, "To maintain a readily available emergency crash cart and assure contents are unexpired ...The crash cart integrity will be checked each shift by the Charge Nurse. The Crash Cart check form will be initialed. The defibrillator will be checked and discharged each shift ...Nursing personnel will check the integrity of the seal on each shift. Respiratory staff will check the cart on a monthly basis for expired non-medical items and replace them as needed."

Review of policy titled "Nursing: Blanket/IV Fluid/Irrigation Fluid Warmer" read in part, "To monitor temperature to assure temperature does not exceed recommended temperature ...The warmer will be checked each shift by nursing staff."

Finding:

Crash Cart Access

On 05/19/21 at approximately 11:10 AM, drawer #2 of the Medical Surgical Unit crash cart was observed to be able to be opened with no palpable, mechanical resistance from the closed, vertical metal bar bearing a red, plastic lock #23294 that remained intact and attached to the opened crash cart.

On 05/19/21 at approximately 11:10 AM, Staff F stated the following:
1. The purpose of securing the crash cart was to keep the public from accessing its contents.
2. The red plastic lock should have popped off when the crash cart drawer was opened to notify staff the crash cart needed to be restocked.

Expired Supplies

On 05/19/21 from 11:09 AM to 12:15 PM, the Medical Surgical Unit crash cart was observed with the following expired items:

On top:
1. One package of Medline Pediatric Defibrillation pads Lot #Y082317-07 with an expiration date of 08/24/20 (9 months past due)

Drawer 2:
1. Two IV start kits with expiration dates of 01/31/20 and 07/31/20 (16 months and 10 months past due, respectively)

Drawer 5:
1. Two packages of Medline Pediatric Defibrillation pads Lot #Y082317-07 each with an expiration date of 08/24/20 (9 months past due)
2. One package of a Nebulizer Tee, tubing, and mouthpiece Lot #02M1200956 with an expiration date of 12/2017 (42 months past due)

On 05/19/21 at approximately 11:33 AM, Staff F observed the expired contents in and on the crash cart and stated the following:
1. The expired defibrillator pads could produce an inaccurate rhythm tracing.
2. The expired IV start kits' alcohol swabs could be dry and not disinfect.
3. The expired nebulizer tee package could cause a delay in treatment.

Crash Cart Checks

A review of the Medical Surgical Unit document titled "Crash Cart Check List To Be Done Each Shift" read in part, "Defibrillator ...Plugged In ...Charged" and showed no documentation the defibrillator was checked during the morning (AM) and evening (PM) shifts on the following dates:

March 2021: 5th AM, 9th PM, 12th AM, 19th AM, 27th AM, 30th AM

On 05/19/21 at 11:50 AM, Staff E reviewed the Crash Cart Check List documentation and stated there were missed crash cart checks in March which could have put patients at risk during a code blue.

Temperature Checks

A review of a document titled "Blanket Warmer Temperature Log" for the Medical Surgical Unit showed no documentation the blanket warmer temperature was checked on the following dates:

May 2021: 1st AM, 6th PM, 8th AM, 9th AM, 14th AM, 16th AM, 17th AM

On 05/19/21 at 12:02 PM, Staff E reviewed the Blanket Warmer Temperature Log and stated there were missed checks in May which could have put patients at risk of a skin burn.

Based on observation, record review and interview, the hospital failed to ensure medications were not expired for one (Medical Surgical Unit) of two patient care areas.

This failed practice has the likelihood to result in the prolonged or worsened clinical condition of patients.

Review of policy titled "Drug Room: Outdated Drug Control" read in part, "Extreme care must be exercised that no outdated medications are ...allowed to remain in ...patient areas. The Drug Room personnel will constantly check all medication physically for dated items and remove all outdated packages ...Nursing stations will be checked periodically for outdated items with replacement effected immediately."

Finding:

On 05/19/21 at approximately 11:25 AM, two 20mL vials of Dobutamine 250mg, each with an expiration date of 03/01/20 (15 months past due), was observed in drawer #4 of the Medical Surgical Unit crash cart.

On 05/19/21 at 11:29 AM, Staff F observed the expired Dobutamine vials and stated they could possibly cause an arrhythmia issue and should not have been in the crash cart.