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Based on observation, interview, and record review, the facility failed to ensure expired supplies in the pediatric crash cart, expired medications in the crash cart, and expired supplies in the emergency department were replaced prior to their expiration date. This deficient practice had the potential to affect any patient requiring the need for these supplies or medications. Findings include:

During an observation on 6/4/24 at 11:05 a.m., the pediatric crash cart was observed to have the following items:

-1 pink pediatric Broselow/Hinkle airways oxygen delivery module with an expiration date of 3/31/24,
-1 pink pediatric Broselow/Hinkle airways oxygen delivery module with an expiration date of 4/30/24,
-1 pink I-gel pediatric airway (2-5 kg) with an expiration date of 11/2023,
-1 blue I-gel pediatric airway (5-12 kg) with an expiration date of 11/2023,
-1 Miller S-1 glidescope with an expiration date of 9/24/23,
-1 LoPro S2 glidescope airway (1.8-10 kg) with an expiration date of 9/20/22,
-1LoPeo S2 glidescope airway (10-18 kg) with an expiration date of 5/31/22,
-1 purple Broselow/Hinkle pediatric airway system with an expiration date of 2/29/24,
-1 purple Broselow/Hinkle pediatric airway system with an expiration date of 5/31/24,
-1 yellow Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 white Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 white Broselow/Hinkle pediatric airway system with an expiration date of 2/29/24,
-1 blue Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 blue Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 orange Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 orange Broselow/Hinkle pediatric airway system with an expiration date of 2/29/24,
-1 orange Broselow/Hinkle pediatric airway system with an expiration date of 5/31/2,
-1 green Broselow/Hinkle pediatric airway system with an expiration date of 2/28/24,
-1 green Broselow/Hinkle pediatric airway system with an expiration date of 2/29/24,
-1 green Broselow/Hinkle pediatric airway system with an expiration date of 5/31/24, and
-1 white I-gel pediatric airway (25-35 kg) with an expiration date of 11/2023.

During an observation at 11:25 a.m., the crash cart was observed to have the following expired medications:

-2 multidose vials of Nitroglycerin 50mg/10ml with an expiration date of 4/24,
-2 multidose vials of Potassium Chloride 40mEq/20ml with an expiration date of 2/1/24, and
-4 1000ml IV bags of 5% dextrose and 0.45% sodium chloride with an expiration date of 3/24.

During an interview on 6/4/24 at 11:30 a.m., staff member I stated it was her responsibility to look for outdated items in the emergency room. Staff member I stated she had just got done going through the emergency room looking for outdated items. Staff member I stated she checked the emergency room weekly at a minimum, but she usually did so three to five times a week.

During an observation on 6/4/24 at 11:40 a.m., the following ED supplies were observed to be expired:

-4 gastroccult test cards with an expiration date of 10/23,
-78 FUL-GLO fluorescein sodium sterile ophthalmic strips 1.0 mg with an expiration date of 3/31/24, and
-1 tube of 100 silver nitrate applicators with an expiration date of 3/24.

During an interview on 6/4/24 at 12:45 p.m., staff member B stated, "[staff member I] goes though the crash carts and looks for expired items in the locked areas and CS does all the other supplies. I am not sure why those items were missed. I know [staff member I] just went through the ER looking for expired medications."

During an interview on 6/5/24 at 9:00 a.m., staff member AA stated, "I do not check the crash carts, they are to be locked. It is my understanding that if it is locked, I do not touch it. That is nursing's responsibility. I do check IV fluids and was surprised that expired IV bags were found. I'm not sure where those came from."

A review of a facility policy titled, "Emergency Drugs and Biologicals," undated, showed the policy lacked information regarding expired supplies in the Emergency Room.

Based on interview and record review, the facility failed to inform patients and/or their representatives of their rights prior to providing or discontinuing care for 2 (#s 22 and 23 ) of 23 sampled patients. This deficient practice had the potential to affect the exercise of rights for all patients receiving care in the facility. Findings include:

A review of patient #22's medical record showed the patient had come to the emergency department on 5/6/24 and was transferred to another facility on 5/6/24. There was no signed acknowledgement of patient rights in the medical record.

A review of patient #23's medical record showed the patient had come to the emergency department on 5/29/24 and was discharged home on 5/29/24. There was no signed acknowledgement of patient rights in the medical record.

During an interview on 6/5/24 at 1:16 p.m., staff member B stated the facility did not have a signed acknowledgement of patient rights in the emergency department. Staff member B stated, "We really should have the patient sign them (patient rights acknowledgement)."

Review of a facility policy titled, "Social Services Resident Rights," with an effective date of 3/2018, showed:

"Facility (Scope): Nursing Home, Critical Access Hospital, and Intermediate Swing Beds."

The policy did not include or address patient rights for the Critical Access Hospital, only the swing bed intermediate patients.