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Based on observation and interview, the provider failed to ensure multiple supplies kept in the emergency room were not outdated. Findings include:

1. Observation on 12/2/14 beginning at 3:45 p.m. in the emergency room revealed the following items were still available beyond their expiration date:
*Two of two Stat CO2 (carbon dioxide) detectors expired 5/24/13.
*Two of two Ambu CO2 detectors expired May 2011.
*Two of three cuffed tracheal tubes (tube placed down throat to allow the patient to breathe) expired December 2009.
*One of one Quicktrach (items used to insert a tracheal tube) expired February 2013.
*Eleven of eleven TB (tuberculin) syringes expired July 2012.
*Six of six 5-0 Prolene nonfilament sutures (stitches) expired August 2009.
*One of one box of one dozen 6-0 Prolene sutures expired July 2010.
*One of one box of one dozen 6-0 Prolene sutures expired January 2012.
*Six of six 4-0 chromic gut sutures expired July 2010.
*Eight of eight silver nitrate applicators (used on wound edges to control bleeding) expired July 2010.
*One of one three-by-three inch adaptic dressings (moisture-retaining coverings for wounds) expired August 2010.
*Two of two three-by-three inch adaptic dressings expired December 2007.
*One of one box of three-by-eight inch adaptic dressings expired April 2013.

Interview at the above time with the director of nursing revealed the nurses checked medications in the emergency room for outdates monthly. She confirmed the supplies were not checked routinely and were replaced when needed. She stated they did not have a policy regarding checking for outdated supplies.

Based on record review and interview, the provider failed to maintain a log of the surgical suite room temperature and humidity. Findings include:

1. On 12/2/14 the provider was asked for the monitoring system logs for the operating room temperature and humidity. At 3:27 p.m. that day the director of nursing confirmed there had been no log. She stated the maintenance director would let her know when the temperatures were out of range. She had know idea as to the frequency of out of range findings. On 12/3/14 at 10:15 a.m. the maintenance director confirmed he visualized the gauges but did not complete a log. He was unable to state how often the findings were out of range.

Review of the maintenance director's Maintenance Checklist revealed a line item that stated "OR [operating room]-Surgical Room-Temp [temperature]." The checklist revealed it had been checked monthly with no numerical findings documented.

Review of Association of periOperative Registered Nurses website (http://www.aorn.org/clinicalfaqs/evironmentofcare/#b) accessed on 12/4/14 revealed the temperature and humidity "should be monitored and recorded daily using a log or electronic documentation of the heating, ventilation, and air condition (HVAC) system."

Based on record review, interview, and policy review, the provider failed to ensure:
*Four of five randomly sampled patients' (28, 29, 30, and 31) medical records Report of Operation (ROP) indicated the date and time of the physician signature.
*Three of five randomly sampled patients' (28, 29, and 31) medical records indicated the time the History and Physical (H and P) had been signed.
*One out of five randomly sampled patient's (31) medical records indicated the time the surgical consent had been signed.
Findings include:

1. Review of patients 28, 29, 30, and 31's medical records revealed a ROP that had been signed by the surgeon. Those reports did not indicate the date or time the reports had been signed.

2. Review of patients 28, 29, and 31's medical records revealed an H and P had been completed. Those reports did not reveal the time they had been signed.

3. Review of patient 31's medical record revealed a surgical consent. That surgical consent did not indicate the time it had been signed.

4. Interview on 12/2/14 at 3:27 p.m. with the director of nursing confirmed the above findings. She confirmed all the entries in a medical record needed to be signed, dated, and timed.

Review of the provider's revised August 2004 Documentation policy revealed "All entries must be in chronological order and MUST contain month, day, year, and time (MILITARY TIME ONLY)."