HospitalInspections.org

Based on observation and interview, it was determined the facility failed to ensure multi-dose medications (Acetylcysteine) in the Respiratory Care Department were drawn up in a designated clean medication area that wasn't adjacent to an area where potentially contaminated items were placed. The failed practice placed the patients at risk of cross contamination and had the potential to affect all patients who received inhaled Acetylcysteine. The findings follow:

A. Observation during a tour of the Respiratory Care Department on 08/15/12 revealed a refrigerator located in the "Dirty Room". Acetylcysteine 200 mg/ml vials were stored in the refrigerator. The refrigerator was located in a room with two Arterial Blood Gas machines and the supplies to run the Arterial Blood Gases. There was no segregation from the refrigerator (clean equipment and medications) and the Arterial Blood Gas machines (dirty equipment).

B. In an interview with Certified Respiratory Therapist #1 on 08/15/12 at 1155, when asked where the Acetylcysteine was drawn up for patient use, she stated in the "Dirty Room".