HospitalInspections.org

Based on observation, staff interview, and policy review, the critical access hospital (CAH) failed to ensure outdated drugs and biologicals were not available for patient use in 1 of 4 departments (physical therapy) of the CAH that stored drugs and biologicals. Findings include:

A tour of the physical therapy department was conducted on 9/28/11, at 8:45 a.m. with the Director of Rehab Services. The following medications were observed and were labeled as expired or lacked dating when opened:

-1 opened multi-dose vial of dexamethasone dated as opened 7/11/11, and labeled as expiration date of 7/12.
-3 opened multi-dose vials of dexamethasone labeled with a sticker but no dates written in on label regarding open date or expiration date.
-1 opened multi-dose vial of dexamethasone dated as opened 1/20/11, no expiration date listed.

The Director of Rehab Services verified the findings and stated that pharmacy does check the medications monthly. He stated he thought the opened vials were good for one year but would check with pharmacy.

On 9/28/11, at 10:45 a.m. the Director of Rehab Services stated he had checked with pharmacy and that the vials are to be discarded 30 days after being opened.

Review of the facility policy titled "Obtaining Dexamethasone Sodium Phosphate For Rehabilitation Patients" dated 7/11, indicated that once a patient is discharged or vial is outdated (longer than 30 days) it is disposed of following pharmacy practice.

Review of the facility policy titled "Multi-Dose Vials" dated 7/11, indicated that, "it is the policy of the pharmacy department that all multi-dose vials of medications will be dated upon opening and discarded after 28 days to reduce the chance of contamination."

Based on observation and interview, the critical access hospital (CAH) failed to ensure proper sanitation measures in the dietary department. This had the potential to affect all patients residing in the CAH. Findings include:

During an environmental tour on 9/28/11, at 9:30 a.m. the kitchen located on the medical surgical floor had a countertop microwave oven with two areas on the interior ceiling of the microwave approximately one to one and a half inches in diameter where the paint had peeled and was hanging off of the surface.

On 9/28/11, at 3:10 p.m. the registered dietician (RD-1) stated the condition of the microwave was not acceptable. She was uncertain who was responsible for the maintenance of this equipment, stating the dietary department only supplies food to this kitchen.

The housekeeping supervisor was interviewed on 9/28/11, at 10:10 a.m. and stated it was not their department's responsibility for maintaining the equipment and was not sure which department would have that responsibility. The CAH was unable to provide a policy regarding the maintenance of this kitchen.

During the tour of the dietary kitchen on 9/28/11, at 8:55 a.m. 5 of 7 frying pans were found to be heavily scored and had approximately one-third to two-thirds of the non-stick coating missing. At this time, RD-1 agreed that these pans should not be in use.

Based on observation, interview, policy review, and review of manufacturer's guidelines, the critical assess hospital (CAH) failed to ensure proper procedures to reduce the risk of burns or fires related to the use of an electrosurgical pencil/blade (instrument used to cut and cauterize tissue during surgical procedures) were followed for 2 of 2 patients (P1, P2) in the sample where an electrosurgical pencil/blade was utilized used during a surgical procedure. Findings include:

Standard safety procedures related to the use of an electrosurgical pencil/blade during surgery were not implemented on 9/27/11, for P1 and on 9/28/11, for P2.

P1 was observed at approximately 2:25 p.m. on 9/27/11, during a cataract extraction procedure. Throughout the procedure the electrosurgical cautery pencil/blade was observed to be placed on top of the patient's abdomen when not in use by Surgeon-A. At 2:45 p.m. upon completion of the procedure RN-A stated the surgeon activated the cautery device using a foot pedal that was placed on the floor next to his feet. RN-A verified the cautery device was activated at the beginning, and again at the end to the procedure. In addition, RN-A verified the electrosurgical pencil was laid on top of P1's abdomen between use and not in a holster.

P2 was observed at 11:05 a.m. on 9/28/11, during a laparoscopic gallbladder surgical extraction. P1 was intubated (artificial airway). Surgeon-2 was observed to activate an electrosurgical cautery pencil using a foot pedal placed on the floor near his feet. Surgeon-2 was observed activating the cautery device twice during the observation. Throughout the surgery, the cautery device was observed to be placed across P2's upper chest next to the facial surgical drape when not in use. At 2:20 p.m. RN-A verified the surgeon activated the cautery device using a foot pedal placed on the floor near his feet. In addition, RN-A stated facility practice was to lay the laparoscopic electrosurgical pencil across the patients chest in between use.

The 10/10, "Procedure For Use of Electrosurgical Units" policy and procedure directed staff to use the device according to the Operation's Reference manual. Review of the manual revealed it lacked instructions/guidelines on safe placement of the cautery device when not in use during a surgical procedure.

On 9/28/11, at 2:10 p.m. RN-B verified all surgical procedures required the holstering of the electrosurgical cautery tool stating the device had not been holstered during the 9/27/11, procedure.

On 9/28/11, at 3:25 p.m. RN-A verified the facility did not have holsters for the laparoscopic cautery device. In addition, RN-A provided a copy of the Association of periOperative Registered Nurses (AORN) electrosurgical guidelines #5-14. Guideline #5 indicated cautery devices that did not fit in a holster should be placed in a designated location away from flammable material such as surgical drapes.

The manufacturer, "COVIDIEN Energy-based Devices" had faxed customer guidelines to the CAH which also indicated the electrosurgical device should be placed in holster or in a clean, dry, non conductive, and highly visible area not in contact with the patient as inadvertent contact with the patient may result in burns.

On 9/29/11, at approximately 8:10 a.m. the director of surgical services verified the electrosurgical cautery pencils/tools should be placed in a safe area or holster and that stated that "as of today" the surgical staff was working on changing their practice.