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Based on observation and interview, the hospital failed to dispose of expired medications and continued to store them in the designated area on the medical/surgical floor where medications were pulled to administer to patients. This failed practice was likely to cause patients to receive expired medications which may not be as effective and could negatively affect the healing process. The findings are:

A. On 03/14/12 at 09:20 am, observation of the medication storage area was conducted with the Director of Nursing (DON). The following medications were found to be expired:
1. 10 4-milligrams (mg) per 1 milliter (ml) pre-filled syringes for individual use of hydromorphone, with an expiration date of 02/2012. This drug is used for moderate to severe pain.
2. 1 100-units per ml vial of Humulin N, with an expiration dated of 02/2012. This drug is used for moderate to severe diabetic ketoacidosis.
3. 2 1-mg per ml vials of epinephirne, with an expiration dated of 04/2010. This drug is used for bronchospasm, hypersensitivity reactions and anaphylaxis.

B. During an interview on 03/14/2012 at 10:40 am, the DON stated that these medications were expired and should be removed from the area. When asked what effect the expired drugs could have, she stated, "They could be ineffective."

Based on interview and documentation review, the hospital failed to ensure that all outpatient services were accountable to a single individual who directs the overall operation of the department. The failure to have one director of Outpatient Services increases the likelihood that different outpatient services would not be coordinated with other hospital services. The findings are:

A. On 03/15/12 documentation of the hospital's Outpatient Services was reviewed. The documentation did not indicate a director of Outpatient Services had been identified.

B. On 03/15/12 at 9:30 am the Chief Executive Officer of the hospital was asked if one person had been designated to be in charge of all Outpatient Services. She stated, "No, there is not one person in charge of all Outpatient Services."

Based on record review and staff interview, the hospital failed to ensure the initial assessment was comprehensive for 6 of 6 sampled swing-bed patients (# 1 through 6). This failed practice could lead to patient issues that would not be addressed during their stay at the hospital. The findings are:

A. Review of Patient #1 through 6's Initial Assessment and Initial Interview revealed that the comprehensive assessment of the resident's needs failed to include an assessment of the following: (ii) patient's customary routine, (v) vision, (xi) dental status, and (vi) mood and behavior patterns.

B. On 03/15/12 at 10:45 am, during an interview, a floor nurse confirmed the initial assessment did not have these areas included in the assessment.