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Based on observation and interview, the Critical Access Hospital failed to ensure that all patient care equipment is maintained in a safe operating condition as evidenced by having expired patient care equipment/supplies in the crash cart.
Findings:

On 12/10/18 at 1:10 p.m., observation of the emergency crash cart in the nurses station revealed the following supplies were expired: Triple lumen catheter (expired 05/21/18) and pediatric defibrillator pads (expired 10/01/18). At that time, S1DON confirmed the supplies were expired and available for patient use.

Based on observation and interview, the Critical Access Hospital failed to ensure that outdated, mislabeled or otherwise unusable drugs or biologicals are not available for patient use.
Findings:

Observation of Rooms a, b and c on 12/10/18 at 1:35, accompanied by S2RN, revealed the following:
Room "a" - six 100 ml bottles of normal saline irrigation solution with an expiration date of 11/15/18.
Room "b" - six 100 ml bottles of normal saline irrigation solution with an expiration date of 11/15/18.
Room "c" - one 100 ml bottle of normal saline irrigation solution with an expiration date of 11/15/18.

During an interview on 12/10/18 at 1:45 p.m., S2RN acknowledged the expired saline solutions.

Based on interview and observation, the Critical Access Hospital failed to provide nursing care in accordance with the patient's needs and the specialized qualifications and competence of the staff available by failing to ensure the Emergency Department staff were trained in non-physical intervention skills for 7 of 7 (S2RN, S6RN, S7RN, S8LPN, S9RN, S10RN, S11LPN) Emergency Department nursing staff members.
Findings:

During an interview on 12/13/18 at 12:50 p.m., S1DON revealed that all staff in Emergency Department were subject to working with violent/psychiatric patients. When asked if any of the Emergency Department staff had current training in non-physical intervention skills, she stated no. She further confirmed that S2RN, S6RN, S7RN, S8LPN, S9RN, S10RN and S11LPN worked in the Emergency Department and were not certified in non-physical intervention skills.

Based on record review and interview, the CAH failed to ensure that each patient was evaluated for proper anesthesia recovery by a qualified practitioner before discharge from the CAH as evidenced by the CRNA failing to document, sign and date a post-anesthesia evaluation or follow-up report for 5 of 5 patients (#1, 2, 3, 4, 5) who received anesthesia services.
Findings:

Review of the CAH's policy for Immediate Post Anesthetic Care revealed the following:
A notation shall be made of pre-anesthetic and post-anesthetic medication along with a brief statement of the patient's condition at the close of the operation.

Review of the medical records for patients #1-5 revealed the patients received anesthesia services on 10/26/18 administered by S3CRNA. Further review of the medical records revealed the post-anesthesia evaluation documented by the CRNA contained a record of vital signs only. There was no documented evidence of an assessment of the patients' cardiopulmonary status; level of consciousness; follow-up care or observations; or complications occurring during post-anesthesia recovery. Further, the post-anesthesia section of the patients' record was not signed, dated and timed by S3CRNA.

On 12/10/18 at 3:00 p.m., during review of the medical records for patients #1-5, an interview with S5RN, Director of Surgical Services confirmed the post-anesthesia documentation by S3CRNA did not contain a complete assessment of the patients' recovery status and was not signed, dated and timed by the CRNA.