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Based on observations and interviews, it was determined that the hospital did not ensure that all medications found in the operating room and emergency department crash carts were within the manufacturers' printed expiration dates.

Findings include:

1. On 3/1/2016, at 1:40 P.M., an inventory of all medications in the crash cart of the operating room was taken. There were three Calcium Vials with an expiration date of February 2016. There were two Lidocaine vials with expiration dates of February 2016 and two more Lidocaine vials dated December 2015. There was one Dobutamine bag with an expiration date of February 2016.

On 3/1/2016, at 1:45 P.M., the manager of surgical services observed the expired medications in the crash cart. She agreed that they were expired and should not have been in the cart.

2. On the afternoon of 3/1/2016, an inventory of all medications in the emergency room crash cart was taken. The following medications were noted:

Guca-Gen 1 milliliter (ml) for injection times 1 vial with an expiration date of February 2016

Twenty ml of Doprane Injection 400 milligrams (mg) times 1 vial with an expiration date of June 2013

Pitressin 1 ml 20 units/ ml x 5 vials with an expiration date of January 2016

Lidocaine drip 500 ml x 1 vial with an expiration date of January 2015

Dobutamine 2000 micrograms per ml in 500 ml of 5 % dextrose with an expiration date of January 2015

Two hundred and fifty ml of 5% dextrose with an expiration date of February 2016.

On the afternoon of 3/1/2016, the manager of emergency services observed the expired medications in the crash cart and agreed that they were expired and should have been removed from the crash cart.

Based on observation and interview, it was determined that the hospital did not ensure that all direct care staff practiced appropriate handwashing and sanitizing of intravenous (IV) ports. Additionally, the hospital's ice machine's drainage system did not meet the international plumbing code for indirect waste.

Findings include:

1. On 3/1/2016, at 10:00 A.M., a colonoscopy was observed in the operating room. The certified registered nurse anesthetist (CRNA) was observed to pick up a large prefilled, unlabeled syringe containing a white substance and proceeded to access the patient's IV tubing port. It was observed that prior to attaching the prefilled, unlabeled syringe, the port was not sanitized.

The CRNA should have labeled his syringe and sanitized the IV port before accessing it. The CRNA could have accidentally given the wrong medication and or accidentally introduced bacteria into the IV port.

2. On 3/1/2016 at 10:32 A.M., a patient arrived at the laboratory for a blood draw. The lab technician (LT) washed his hands and put on a pair of gloves. The LT then stated he forgot his "sharpie". He walked over to the desk, patted the desk and moved objects looking for the sharpie. He went into another room, upon returning he touched the pocket of his scrubs and stated the sharpie was in his pocket the whole time. He took the sharpie out of his pocket and wrote information on a vacutainer. He prepped the patient's arm and obtained the blood sample.

After touching many objects, the LT did not wash his hands nor change his gloves prior to obtaining the blood sample.

3. On 3/1/2016, at 3:20 P.M., the hospital's kitchen was observed. The ice maker's drain tubing was observed to be inserted into the floor drain by approximately 8 inches. There was no air gap between the end of the drain tubing and the floor drain to prevent back flow and contamination problems. There was no backflow valve observed and per interview there was no backflow valve. Additionally, the tubing from the ice bin and the refrigeration coils were joined together.

According to the "2009 International Plumbing Code" chapter 8 page 69:

802.1.3 "Potable clear-water waste. Where devices and equipment....discharge potable water to the building drainage system, the discharge shall be through an indirect waste pipe by means of an air gap."

Plumbing Code in Commercial Kitchens, City of Concord, Code Administration 225-8580 page 10: "The ice in the bin is either considered potable water or food therefore requires an air gap. The condensation drain coming from the refrigeration equipment is normally accompanied by a nasty slime and must NOT be communicating with the drain from the ice bin. The drains must be separate and not tied together. "