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Based on observation, hospital record review, and interview the hospital failed to ensure that outdated drugs were not available for patient use.
On 12/2/14 at approximately 3:15pm an observation was conducted of the hospital's pharmacy department. During this observation, a random sample of medications that were on the shelves for use were selected and reviewed for appropriate labeling. During this review, it was observed that four medications had expiration dates that had passed including: Glyburide 2.5mg which showed an expiration date of 8/5/14; Galantamine 4mg which showed an expiration date of 10/25/14; Labetalol 200mg which showed an expiration date of 10/14 and Vitamin B6 50mg which showed an expiration date of 8/3/14.
The pharmacist provided a notebook that contained forms showing where the medications had been reviewed monthly to ensure that no outdated medications were on the shelves. The last audit that had been documented in the notebook had taken place in July 2014.
Review of the hospital policy for storage of expired medications showed that all expired medications should have been stored in a clearly defined area separate from medications that are not expired.
On 12/2/14 at approximately 3:45pm and interview was conducted with the pharmacist who stated that prior to the hospital moving from its old location, there had been an employee who had been responsible for auditing the drugs monthly to ensure that there were no expired medications on the shelves but stated that those job duties had been taken from the employee. He stated that he always checked the expiration dates of the medications prior to dispensing them but did admit that the day shift and night shift nursing supervisors had access to the pharmacy and could pull medications for the patients.
On 12/3/14 The pharmacist provided an action plan that stated he would be resuming the log for outdated medications and that on the first Saturday of each month, he would complete an inspection of the pharmacy stock and remove any expired medications from stock and apply " dot stickers " to the medications bins as a quick visual reference of the month the medications were due to expire.

Class III

Based on interview and record review, the facility failed to ensure the electronic health records contained the completed information from the Florida Emergency Management System Report for 1 of 2 hospital transfer record reviews (Patient #9); and failed to contain the completed information for the Certification of Transfers Between Hospitals for 2 of 2 hospital transfers reviewed. (Patients #9 and #10).
Findings:
On 12/4/14 at approximately 11:45am a closed record review of the electronic health record was conducted in the presence of the Emergency Department manager for 2 patients who had been transferred to hospitals for provision of higher level of care.
Patient #9 presented to the Emergency Department on 11/17/14 and was diagnosed with a femur fracture requiring surgical intervention for which this hospital does not provide services. Patient was transferred to a higher level of care on the same. Review of electronic health record included a "Physician Assessment and Certification" which was not legible. Further review included the Emergency Management System (EMS) ambulance report with none of the documentation on the report appearing on the viewing of the electronic record.
Patient #10 presented to the Emergency Department on 11/17/14 and was diagnosed with leukocytosis (elevated white blood cell count) and fever of unknown origin. Physician documentation included notation of "sickle cell crisis" and patient was transferred to Tallahassee Memorial Hospital, an acute care hospital that has written transfer agreement with this facility. The electronic health record review conducted in the presence of the ED manager failed to include reason for the transfer as confirmed by the manager at the time of the review. The ED manager stated the certificate of transfer would document reason for transfer. Review of the electronic health record included a "Physician Assessment and Certification" which was not legible.
An interview was conducted with the facility's Health Information Management (HIM) Supervisor, in the presence of the Emergency Department Manager, on 12/4/14 at approximately 12:10pm. This surveyor was informed that the facility is currently utilizing both electronic documentation and paper documents. The HIM supervisor stated both the "Certifications of Transfers" and "Florida Emergency Medical Services Reports" are paper documents that are scanned to become part of the electronic record prior to disposal of the paper documents. The HIM manager stated the documents she receives are copies instead of originals which prevents the text from scanned document to be readable; and confirmed the scanned "Certifications of Transfers" within the EHR for patients #9 and #10 could not be read.