HospitalInspections.org

Based on observation and staff interview the Critical Access Hospital failed to ensure that expired medications were removed from stock to prevent use for patient care in 1 of 3 crash carts. Observation of the Emergency Room crash cart revealed 2 (Narcan [medication given to reverse effects of opioids] and Amiodarone [medication given to treat heart arrhythmia's]) medications were outdated for use. The lack of removing medications after outdated has the potential to affect emergency room patients requiring these medications.

Findings are:

A. An observation of the medications in the drawers of the Emergency Room crash cart on 1/5/17 at 2:15 PM revealed:
-Three boxes of Amiodarone 150 mg (milligrams) / 3 ml (milliliter) with an expiration date of 12/2016.
-Three vials of Narcan 0.4 mg/1 ml with an expiration date of 9/2016.

B. An interview with the Director of Nurses on 1/5/17 at 2:15 PM stated, "The crash carts are to be checked for outdates every month and the outdates are to be removed and replaced. This job is assigned to a different nurse every month." The Director of Nurses verified the Amiodarone and Narcan in the cart had expired dates for use on them.

Based on a review of the Computerized Tomography (CT) manufacturer's instruction manual, quality control record review and staff interview, the CT Radiology services furnished by the Critical Access Hospital(CAH) failed to ensure patients were protected from unnecessary radiation hazards. (A Computerized Tomography Scanner provides multiple 'slices'of images of soft tissue and internal organs, used to identify abnormalities and diagnose disease by use of higher doses of ionizing radiation)

The facility reported a total of 947 inpatient and outpatient CT scans performed during the most recent fiscal year.

This failed practice had the potential to affect all patients receiving this service at the CAH.

Findings include:

1. The manufacturer's instruction manual under Responsibilities of the Quality Control Technologist, labeled, Technologist's QC Tests:' Minimum Frequencies' listed the phantom test performance frequency as 'daily', and appropriate control limits recorded. (A phantom is an acrylic, fluid filled device that mimics the size and density of human tissue and provides expected readings, to the technologist to ensure the instrument is functioning properly prior to performing patient testing).

2. A review of the Phantom test log results from 12-1-2016 to 1-10-2017 revealed the phantom test was performed on week days, but not on weekends.

3. During a tour of the Radiology Department on 1-10-2017 at 1:30 P.M. with the Department Director, the CT technologist confirmed that the phantom was not performed routinely on weekends, as specified by the manufacturer.

Based on medical record review of surgical records and staff interview; the CAH (Critical Access Hospital) failed to ensure that one of three surgeons failed to examine three patients (5, 26, and 27) immediately before surgery to evaluate the risk of the procedure to be performed. This failed practice had the potential to affect all surgical patients of the hospital.

Findings are:

A. Review of Resident 26's medical record on 1/5/17 at 10:10 AM revealed the patient had a right distal radius open reduction with internal fixation (broken wrist requiring surgical hardware) on 12/8/16. Review of the entire medical record revealed the lack of evidence of a physician exam immediately before surgery to evaluate the risk of the procedure to be performed. The Physician's Pre-Evaluation Assessment Sheet was not checked which indicated that the patient was not examined before surgery.

B. Review of Resident 27's medical record on 1/5/17 at 10:30 AM revealed that the patient had a left shoulder arthroscopy with rotator cuff repair (scope of the left shoulder to repair torn tendons back to the arm bone) on 11/10/16. Review of the entire medical record revealed the lack of evidence of a physician exam immediately before surgery to evaluate the risk of the procedure to be performed. The Physician's Pre-Evaluation Assessment Sheet was not checked which indicated that the patient was not examined before surgery.



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C. Review of Resident 5's medical record revealed the patient had a left total knee replacement on 8/18/16. Review of the entire medical record revealed the lack of evidence of a physician exam immediately before surgery to evaluate the risk of the procedure to be performed. The Physician's Pre-Evaluation Assessment Sheet was not checked which indicated that the patient was not examined before surgery.

D. Interview with the Director of Surgery and Outpatient services on 1/5/17 at 10:45 AM confirmed Surgeon A's 3 medical records that were reviewed lacked documentation that the patient was examined before surgery.

Interview with the Director of Surgery and Outpatient services on 1/5/17 at 4 PM revealed that the facility's Policies and Procedures were not updated with the regulation to ensure that patients were examined immediately before surgery to evaluate the risk of the procedure to be performed by the surgeon.