HospitalInspections.org

Based on observations, interview, and review of the facility policy, it was determined the facility failed to ensure all unusable drugs were not stored in an area for patient use.

The findings include:

Review of facility policy "Use of Multidose and Single Dose Medication Vials for injection", not dated, reveals The expiration date for multi-dose medication vials for injection will be 28 days from first entry. Further review of the policy revealed it is nursing responsibility to transcribe the correct expiration date on the attached sticker and place on the vial each time a multi-dose item is removed from the automated dispensing cabinet.

On 11/24/14 at 11:34 AM during a tour of the operating rooms (OR) revealed in OR #2 there were two (2) opened medications, Bacteriostatic Sodium Chloride 0.9% and Xylocaine 2% , on the anesthesia cart with no date to indicate when opened or date when to dispose of medications.

Interview with the Director of Surgery, on 11/24/14 at 11:34, revealed the medications should have been dated when opened.