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Based on observation, it was determined expired supplies were observed in Emergency Department and were available for patient use. Failure to ensure only currently dated supplies were available for patient care had the potential for patients to receive care and medication management with outdated supplies. The failed practice had the potential to affect all patients on census on 08/14/12.

The following was observed in Emergency Room #4 and confirmed at the time of observation by the Risk Manager:
Coated Vicryl suture, one box of 36 count 4-0 expired 07/2012; Coated Vicryl suture, one box of 36 count 5-0 expired 07/2012; Polysorb suture 4-0, 36 count 4-0 expired 04/2012; and Chromic Gut 36 count 4-0 expired on 07/2012.

The following was observed in Emergency Room Nurses Station and confirmed at the time of observation by the Risk Manager:
1) Lidocaine 2.5%/Prilocaine 2.5% cream one of one expired 02/12;
2) Ammonia Inhaler eight of eight expired 07/12;
3) Rocepinephrine Inhalant solution 2.25% four of four expired 05/2012;
4) Acetaminophen Suppository 120 milligram (mg) eight of eight expired 06/12; and
5) Phenergan Suppository 50 milligram (mg) two of two expired 02/12.

Based on observation, it was determined the facility failed to follow it's "Opened Multi-Dose Vials" policy in that opened multi-dosed vials did not contained a recorded expiration date of 28 days from the date in which they were opened. Failure to ensure the dates of discard were recorded on the vial did not assure the efficacy of the medication. The findings follow:

A. Tour of the Emergency Department was conducted on 08/14/12 at 0835 with the Risk Manager. The following was observed and confirmed at the time of observation by the Risk Manager:
1) Sensorcaine 0.5% multidose vial revealed no discard date as per facility policy;
2) Regular Insulin 10 milliliter multidose vial revealed no discard date as per facility policy;
3) Novolog 10 ml multidose vial revealed no discard date as per facility policy;

B. Review of the "Opened Multi-Dose Vials" policy on 08/14/12 at 1000 revealed opened multi-dosed vials/containers were good for 28 days from the date in which they were opened. This expiration date of 28 days would be recorded on the vial either by label or sharpie marker and would be discarded on the recorded expiration date.

AC. The Risk Manager confirmed the findings in an interview on 08/04/12 at 1000.

Based on clinical record review and interview, it was could not be determined the completion date or if the Discharge Summary was documented by the attending Physician for four (#1-#4) of four clinical records. The failure to date and sign the Discharge Summary does not allow for a completed clinical record. The failed practice affected Patient #1-#4 and had the potential to affect all patients seen in the Emergency Department. Findings follow:

A. Based on the current census and the list of admissions for 07/04/12 to 07/06/12, four (#1-#4) closed clinical record and six active (#5-#10) records were selected for review. Review of clinical record #1-#4 revealed the following:

1) Patient #1 was seen in the Emergency Department on 07/05/12 and discharged on 07/05/12. The Discharge Summary did not contain a date or physician's signature 30 days following the patient's discharge date.

2) Patient #2 was seen in the Emergency Department on 07/05/12 and discharged on 07/05/12. The Discharge Summary did not contain a date or physician's signature 30 days following the patient's discharge date.

3) Patient #3 was seen in the Emergency Department on 07/05/12 and discharged on 07/05/12. The Discharge Summary did not contain a date or physician's signature 30 days following the patient's discharge date.

4) Patient #4 was seen in the Emergency Department on 07/05/12 and discharged on 07/05/12. The Discharge Summary did not contain a date or physician's signature 30 days following the patient's discharge date.

B. The above was confirmed by the Risk Manager.