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Based on observation during a tour of the facility and interview, it was determined that the facility failed provide care in a safe setting to ensure that expired medical supplies were removed and replaced in the emergency department.
Findings included:
During a tour of the facility on the morning of 01/21/2020, the following expired supplies were available for patient use.

Emergency Department:
" Trauma Room and Crash cart
IV Catheter 16G 1 ¼ X3 expired 08/2016
IV Catheter 16G 1 ¼ X1 expired 08/2017
IV Catheter 16G 1 ¼ X1 expired 08/2018
Infusion Set 20G 1 ½ X5 expired 10/20/2019
NuGauze Iodoform ½ inch X1 expired 10/2019
Alligator forceps X2 autoclaved closed X 2 dated 12/2017.

" Emergency Room #3
Cabinet under sink dirty with loose particles and large wet/moisture stains.

" Emergency Room #4
Blue top laboratory tubes X2 expired 11/13/2019
IV Catheter 24G ¾ X1 expired 03/2018
IV Catheter 24G ¾ X1 expired 01/2019
15 mm 15g Needle Set expired 08/2018
" Emergency Storage Room
Cabinet under sink dirty with loose particles and large wet/moisture stains.

" Medical/Surgical ICU - Crash Cart
IV Catheter 16G 1 ½ X5 expired 07/2016
IV Catheter 18G 1 ¼ X3 expired 08/2017
IV Catheter 14G 1 ¼ X4 expired 08/2016

In an interview with staff #23 she stated that the Pharmacy staff checked all the supplies in the crash cart for expiration dates. The above findings were confirmed during the same tour with the facility's Chief Nursing Officer.

Based on staff interview and observation, it was determined that the facility failed to ensure an acceptable level of safety and quality of equipment was maintained. Documentation of the specific equipment checked was not available for review.

Findings included:

Policy & Procedure titled "Emergency Room Crash Cart Emergency Supply Checklist" states in part:

Policy: It is the policy of Brownfield Regional Unit to have all required emergency equipment stocked, connected and ready for emergency operation at all times.

Purpose: To establish a method that ensures the ER 1 Crash Cart is adequately stocked and checked each shift and supplies present are verified by secure numerical tabs. To establish criteria for ensuring emergency supplies not contained in the Crash Cart are set up and ready for emergency use.
1. At the beginning of each shift the Emergency Crash Cart in the Major Trauma Room 1 will be checked by the oncoming shift, licensed personnel. This check will ensure the secure the numerical tab is in place relating the previous shift has either not required entry and supplies remain untouched or if entry to the cart has been required. The used supplies have been replaced and a new secure numerical tab has been applied indicating the cart is fully stocked.
4. Emergency equipment checks include the checking of the AED and
defib function as well as ensuring BOTH suction canisters are in place,
attached to regulators with connecting tubing and suction caths.
Yankaur, etc. available for immediate use. Levels of oxygen in the tank
on the side of the cart should also be checked."

Review of the Crash Cart Checklist states:
"By my signature below, I certify that:
1. I have checked the emergency crash cart. The seal is intact indicating supplies are at par level and the seal number is recorded.
2. I have checked the equipment as required.
3. I have reported missing or malfunctioning items to the appropriate person or department."

The above document did not list specific emergency equipment. Surveyor is unable to verify if all required equipment is checked each shift as per hospital policy.

In an interview with staff #23 when asked if the oxygen tank on the side of the emergency cart was included in the "Checklist" she stated, respiratory staff checked all their (respiratory staff) equipment.

Review of the check list for "Airway Box Audits/Critical Access E-Tanks - All areas" by the Respiratory Department, did not list specific areas where equipment is house."

The above findings were confirmed by the CNO during the tour on 01/21/2020 and on 01/22/2020.