HospitalInspections.org

Based on observation and interview the CAH (Critical Access Hospital) failed to dispose of expired medications that were available for patient use in three departments of the facility during tours of the Cardiac Rehabilitation, Therapy Department, and the Emergency Room. This failed practice had the potential to affect all patients of the CAH. The CAH had 93 inpatient admissions in fiscal year 2022.

Findings include:

A. Tour of the Cardiac Rehabilitation and Therapy Department with Chief Executive Officer (CEO) and facility Occupational Therapist (8/8/23 at 8:30 AM) revealed an unlocked cupboard with a green metal box with a pharmacy tag and contained the following medications:

- Dexamethasone (an injectable steroid medication administered by physical therapists for treating patients inflammation) expiration date 1/2018.

-Nitroglycerin tablets (used to treat cardiac rehabiliation patients with chest pain) expiration date 10/2021.

-Oral Glucose (used for patients with potential low blood sugar) expiration date 11/2021.

B. While on tour ( 8/8/23 at 8:30 AM) the CEO (Chief Executive Officer) removed all the expired medications.

C. Interview with CEO (8/9/23 at 3:20 PM) revealed the Pharmacy department was ultimately responsible for tracking expired medications, but all staff were to be knowledgeable of outdates and take expired medications out of patient use areas to be appropriately discarded according to facility policy.




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D. Tour of the Emergency Department area (8/9/23 at 9:30 AM) with the RN Supervisor, revealed 2 Calcium Chloride 10 % 1000 mg/ml injections (a medication used during a cardiac event) expiration dates of 8/1/23 in the crash cart.
E. Interview with RN Supervisor (8/9/23 at 9:30 AM) confirmed they were expired and removed them from the crash cart.

Based on medical record review, review of policies and procedures and staff interview, the facility failed to ensure 2 of 2 outpatient surgery patients (Patients 27 and 28) reviewed lacked documentation of the patient discharged in the company of a responsible adult. This failed practice had the potential to affect all surgical patients of the facility. Total number of surgical cases for fiscal year 2022 was 313.

Findings include:

A. Review of Patient 27's medical record (8/8/23 at 9:07 AM) revealed the patient had a colonoscopy (a procedure to look at the inside of the colon and rectum) under MAC (Monitored Anesthesia Care) sedation on 6/21/23. Review of the entire medical record lacked evidence of the patient being discharged in the company of a responsible adult.

-Review of Patient 28's medical record (8/8/23 at 9:22 AM) revealed the patient had an Esophagogastroduodenoscopy (a procedure to look at the inside of the esophagus, stomach and duodenum) under MAC sedation on 5/3/23. Review of the entire medical record lacked evidence of the patient being discharged in the company of a responsible adult.

B. Review of policy titled Post-Procedure Patient Care (Last revised 6/2023) stated "The patient who received sedation will only be discharged per order to the care of a responsible party and are advised not to drive."

C. Interview (8/10/23 at 2:00 PM) with the RN Supervisor confirmed the lack of documentation of discharge with a responsible adult for the above two patients reviewed.