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Based on observation, interview and record review the facility failed to date and initial two bottles of medication per manufacturers guidelines, medications were used for more than one patient (multi-dose medications). The practice had the potential to affect all surgical patients in the facility. The facility census was five.

Findings included:

1. Record review of the facility's policy titled, "Medication Practices" provided by Staff G, Pharmacist, on 05/17/12, showed the following direction:
- Multi-dose vials must be discarded within 28 days from opening unless the manufacturer's product information states otherwise.

Review of product information provided by Staff G on 05/17/12 for Anectine, a muscle relaxant, used to facilitate tracheal intubation (a tube that is passed down the throat and into the windpipe (trachea) to provide an airway during a surgical procedure) showed the following direction:
- Store in refrigerator at 2 to 8 degrees centigrade (36 - 46 F). The multi-dose vials are stable for up to 14 days at room temperature without significant loss of potency.

Review of product information provided by Staff G on 05/17/12 for Neostigmine, a drug used for tracheal intubation, showed the following direction:
- Protect from light, store in shelf pack until time of use.

2. Observation on 05/15/12 at 9:30 AM, showed the following multi-dose vials in the anesthesia medication cart in operating room (OR) A:
- Anectine, a multi-dose vial, with a date of 06/12/12 (vial was labeled for 28 days) written on the outside. Vial had been opened and medication had been withdrawn from the vial.
- Prostigmine (Neostigmine), a multi-dose vial, with a date of 05/10/12 written on the outside. Vial had been opened and medication had been withdrawn from the vial. Vial was in the drawer with no covering to protect from light when the drawer was open. Drawer is open to light when anesthesia is provided to surgery patients.

During an interview on 05/15/12 at 9:40 AM, Staff D, manager of surgery and obstetrics, stated that the anesthesia nurses are responsible for checking their anesthesia cart.

During an interview on 05/15/12 at 1:25 PM, Staff G stated that Anectine is good for 14 days at room temperature and that Neostigmine should be discarded after use or placed in a bag to protect from light. Staff G stated that he did not normally monitor the anesthesia carts. Staff G stated that he was not doing the monthly checks on the anesthesia carts, but would start doing them.

Based on interview and policy review the facility failed to define the terms "imminent death" and "timely notification" in their Organ/Transplant Donation policy which had the potential to affect all patients who might benefit from a transplant. There were two corneas donated for transplant in 2011.The facility census was five.

Findings included:

1. Record review of the facility policy titled "Organ/Tissue Donation" dated 8/2011 showed no definition for the term "Imminent death" (has clinical findings consistent with a score on the Glasgow Coma Scale (GCS) that is less than or equal to a mutually agreed upon threshold;) or
-is being evaluated for a diagnosis of brain death; or
-has had withdrawal of life-sustaining therapies ordered by a physician, pursuant to the decision of the patient's family.

Record review of the policy did not contain a definition for "timely notification" (referral by a hospital is considered timely if it is made as soon as possible after a patient meets the criteria for imminent death, ideally within one hour).

2. During an interview on 05/16/12 at 3:00 PM Staff L, Director of Risk/Quality, stated that upon her review there was no definition of imminent death or timely notification mentioned in the facility policy.

Based on interview and policy review the facility failed to provide a complete list of Patient Rights for one current swing bed patient (#31) and three discharged swing bed patients (#32,#33 and #34). This had the potential to reduce information, fair treatment, and choice over medical decisions. The facility census was five.

Findings included:

1. Review of the undated policy "Bill of Patients Rights", in the pamphlet "Welcome" provided by the Risk Manager on 05/15/12, showed an incomplete listing of patient rights. Not addressed were the following:
-Choosing a MD/DO (Medical Doctor/Doctor of Osteopathy)
-Participate in treatment and care plan
-To work or not work
-Send and receive mail
-Visit or be visited
-Personal possessions
-Share a room with a spouse
-Advance Directives

During an interview on 05/16/12 at 2:00 PM Staff L, Director of Risk/Quality, stated that some of these things were addressed in the body of the "Welcome" booklet but were not stated as Patient Rights.

Based on interview, record review and policy review the facility failed to have a designated activities director or to provide an ongoing program of activities to meet the individual interests for the physical, mental, and psychosocial well-being for one current patient (#31) and three discharged patients (#32, #33, #34). The facility census was five.

Findings included:

Record review of the facility policy titled "Activity Staff Qualifications" dated 08/2011 showed direction for the facility to ensure the Activity Program for Swingbed patients is directed by a qualified staff member.

Record review of the facility policy titled "Activity Assessment Swingbed" dated 08/2011 showed direction for the nursing and Occupational Therapy staff to document on the Daily Activities Log.

Observation on 05/15/10 at 8:55 AM showed a large (approximately four feet by five feet) dry erase board on the wall of the Med/Surg nursing unit titled Activities. It showed each day of the week with the time of 2:00 PM for "Activities".

During an interview on 05/15/12 at 03:20 PM Staff C, Med/Surg Manager, stated that she was not aware that there needed to be a designated Activities director. She stated that a cart with puzzles, books and other items was brought out at 2:00 PM each day and offered to the patients. She stated that the Occupational Therapist completes the activities assessment and does activities with the patients.

During an interview on 05/15/12 at 3:40 PM Staff U, Occupational Therapist, stated that she does the assessment but that she does not implement activities as the activity director. She stated that her role was to do the assessment but she was not responsible for the activities program.

Record review of Swingbed patients #31, #32, #33, #34's medical chart showed an activities assessment but no documentation was found to show swingbed patients were engaged in planned activities according to their likes and interests. Review of the resident's care plans did not address activities.