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Based on hospital policy review, medical record review, and staff interviews, the hospital's nursing staff failed to assess and monitor the patient receiving blood per hospital policy for 1 of 3 patients receiving blood (Patient #7).

Review of the hospital's policy "Blood Transfusion Inpatient and Outpatient" last revised date of 11/2012 revealed "Adults and Patients greater than 13 years old:...continue to monitor the patient for sign/symptoms of adverse reaction during the transfusion and one-hour post transfusion...take vital signs one hour after the infusion and document in the Nursing Notes and on the blood slip and complete the transfusion requisition..."

Closed medical record review on 06/03/2014 for Patient #7 revealed a 94 year old admitted on 05/29/2014 at 1528 with a chief complaint of "Shortness of Breath". Continued review revealed a Physician Order on 05/30/2014 at 1436 for Packed Red Blood Cell (blood) transfusion.

Review of the "Transfusion Record" dated 05/30/2014 revealed the blood was started at 2040. Continued review revealed the blood was stopped on 05/31/2014 at 0030. Continued review revealed no documentation of the one hour post transfusion vital signs (VS) (should be assessed and documented at 0130).

Review of the Vital Sign Inquiry document revealed no vital signs documented on 05/31/2014 at 0130. Continued review revealed on 05/31/2014 at 0800 documented VS's (7 hrs and 30 minutes post transfusion).

Review of the Nurse's Notes revealed no documented assessment or vital signs on 05/31/2014 at 0130.

Interview on 06/03/2014 at 1505 with Nursing Administrative Staff #1 revealed there is no one hour post assessment of the vital signs documented in the record as required by hospital policy. Interview confirmed the hospital nursing staff failed to assess and monitor the patient receiving blood per hospital policy.

Based on hospital policy, observations during tour, and staff interview the hospital nursing staff failed to maintain safety and quality of supplies as evidenced by failing to date blood glucose control solutions per hospital policy for 4 of 8 opened solutions and failing to perform daily crash cart safety checks for 2 of 4 crash carts. (3rd floor medical surgical unit)

Review of the hospital's policy "Waived Testing" revised date of 03/2011 revealed "Reagent Storage and Stability: Control Solutions: Expiration: Record discard date of 90 days after opening on the control vials..."

Review of the hospital's policy "Crash Cart Maintenance and Stocking" revised date of 12/2010 revealed "EMERGENCY CRASH CART MAINTENANCE: The Emergency Crash Carts are to be checked for readiness by the nursing personnel daily and these checks are documented on the Emergency Cart Checklist..."

Observation during tour on 06/03/2014 at 0840 of the 3rd floor Medical/Surgical nursing unit revealed two (2) blood glucose monitoring containers. Inside each container was a blood glucose monitoring machine, one (1) opened bottle of test strips, (1) opened bottle of high control solution, and (1) opened bottle of low control solution (for a total of (4) control solutions). Review of the (4) opened bottles of blood glucose control solutions revealed no discard date recorded on the control vials.

Interview with the Administrative Staff #2 during the tour and observation revealed all 4 solutions were open and should have been dated by the nurse at the time they were opened with a discard date of 90 days from the open date. Interview confirmed the facility nursing staff failed to maintain safey and quality of supplies by failing to date the blood glucose controls per hospital policy.

Continued observation of the 3rd floor Medical Surgical Nursing Unit revealed two (2) Crash Carts: one adult cart and one pediatric cart. Review of the April 2014 daily crash cart checklist for the adult cart revealed no documentation of crash cart checks on April 5, 6, 8, 9, 21, 22, 23, 24, 28, 29, and 30. (not checked 11 days out of 30). Review of the May 2014 daily crash cart checklist for the adult cart revealed no documentation of crash cart checks on May 4, 14, 18, and 21 (not checked 4 out of 31 days)

Review of the April 2014 daily crash cart checklist for the Pediatric cart revealed no documentation of crash checks on April 5, 8, 9, 28, 29, and 30. (not checked 6 days out of 30). Review of the May 2014 daily crash cart checklist for the Pediatric cart revealed no documentation of crash cart checks on May 14, 18, and 21 (not checked 3 out of 31 days).

Interview with the Administrative Staff #2 during the tour and observation revealed both the adult and Pediatric crash carts are to be checked daily by the nursing staff. Continued interview revealed the carts had not been checked on the dates listed above. Interview confirmed the facility nursing staff failed to maintain safey and quality of supplies by failing to perform daily checks of crash cart as required by hospital policy.

NC00094932