HospitalInspections.org

Based on observation, policy and job description review, and staff interview, the Critical Access Hospital (CAH) failed to ensure the removal of outdated medications from 2 of 2 medication storage areas (nursing medication room and central pharmacy). Failure to remove outdated medications from the facility's medication storage areas may result in patients receiving expired and ineffective medications.

Findings include:

Review of the policy "Disposal of Medications" occurred on 07/10/19. This policy, revised July 2010, stated, ". . . OUTDATES: Medications are checked for outdates by the Pharmacy Technician on a monthly basis in all medication storage areas. Outdated medications are removed from the storage areas at the end of the month during which they expire. . . ."

Review of the "Pharmacist Job Description" occurred on 07/10/19. This job description, dated 06/07/19, stated, "GENERAL DUTIES AND RESPONSIBILITIES: . . . Manages drug outdates. . . ."

Observation, on 07/09/19 at 8:20 a.m., of the nursing medication room showed the following outdated medications:
- 4 E-kits (emergency drug kits) each contained Flumazenil 5 (milliliters) ml expired 10/2018; Atropine Sulfate 1 (milligram) mg expired 6/2018; Naloxone Hydrochloride 2 mg expired 6/2018; 0.9% NaCl (sodium chloride) 30 ml (three expired 6/2018, one expired 7/2018); Solu-Cortef 2 ml (three expired 8/2018); Diphenhydramine 1 ml expired 10/2018; and Epinephrine 1 ml expired 7/2018.
- Unit doses outdated 6/2019: 16 tabs Meclizine 12.5 mg; 10 tabs Acetazolamide extended delivery 500 mg; 17 tabs Diphenhydramine HCL 25 mg; 7 tabs Cyclobenzaprine HCL 10 mg; 25 tabs Ciprofloxacin 50 mg; 20 tabs Carvedilol 6.25 mg; 7 tabs Calcium Carbonate 750 mg; 10 tabs Isosorbide 20 mg; 10 tabs Nitrofurantion macrocrystals; 10 tabs Risperidone 1 mg; 15 tabs Sulfamethoxazole-Trimethoprim 800 mg/160 mg; and 10 tabs Pravastatin 40 mg.
- 1 RSI (rapid sequence intubation) kit contained two Amidate 20 ml expired 5/2019.

Observation, on 07/09/19 at 8:30 a.m., of the nursing medication room fridge showed the following outdated medications:
- 12 Anucort-HC 25 mg suppositories expired 1/2019; 24 Aspirin 300 mg suppositories expired 6/2019; 2 Children's Fever All 120 mcg (microgram) suppositories; and 7 syringes of Fluarix Quad (influenza vaccine) 0.5 mg expired 6/30/19.

Observation on 07/10/19 at 10:15 a.m., of the central pharmacy showed the following outdated medications:
- 1 bottle Timolol Maleate 5 ml expired 4/2019; 2 bottles Cyclopentolate hydrochloride 1% 2 ml expired 4/2019; 1 bottle Atropine Sulfate Ophthalmic 1% 5 ml expired 6/2019; 3 tubes Bacitracin ointment 1 oz (ounce) expired 6/2019; 10 vials of Ampicillin 1 gm (gram) expired 6/2019; 1 bottle Benzoin Tincture 2 oz expired 5/2019; 4 vials Glycopyrrolate 4 ml/200 ml expired 6/2019; 10 vials Keppra 500 mg/5 ml expired 6/2019; 15 tabs Calcium Carbonate 750 mg expired 6/2019; 20 tabs Diphenhydramine HCL 25 mg expired 6/2019; and 1 vial Solumedrol 1 gm expired 5/2019.

Observation, on 07/10/19 at 10:15 a.m., of the central pharmacy medication fridge showed the following outdated medications:
- 6 Granix injection syringes 300 mcg/0.5 ml expired 6/2019.

During interview on 07/10/19 at 10:40 a.m., a staff pharmacist (#3) stated he failed to remove expired medications from the medication rooms and had no system for documentation of monthly medication outdate checks.