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Based on observation, interview and document review, the hospital failed to ensure crash carts that contained emergency drugs were kept locked in a secure area in the hospital's emergency department (ED) and radiology department (RD). This had the potential to affect all patients who received care in the ED and RD.

Findings include:

Emergency medications located in the ED and RD were not securely stored to prevent access by unauthorized persons.

During a tour of the ED with registered nurse (RN)-A at 2:30 p.m. on 6/11/12, a crash cart was observed in trauma room 1, and another crash cart was observed in the hallway next to the nurses' station. The carts were unlocked but had a breakaway tab in place. The crash carts contained medications including: Epinephrine (often used for shock and cardiac arrest), Narcon (a narcotic used for pain control), Lidocaine (an anesthetic), Amiodarone (used to treat cardiac arrhythmia), Atropine (often used to regulate the heart), and Dopamine (improves nerve conduction). According to interview with RN-A during the tour, she stated the crash cart tabs were to be monitored every shift and tracked on a log. Review of the log system revealed not all shifts had been monitoring the tabs. There were no initials documented on several of the shifts.

RN-A verified during interview at 2:40 p.m. on 6/11/12, that the crash carts were not always visually supervised and could be accessed by patients or other unauthorized persons.

During a tour of the radiology department with radiology technician (RT)-B at 11:30 a.m. on 6/13/12, an unlocked crash cart was observed in the hallway of the radiology department near the entrance door. The cart was observed to have a breakaway tab in place. The crash cart contained medications including: Epinephrine (often used for shock and cardiac arrest), Narcon (a narcotic used for pain control), Lidocaine (an anesthetic), Amiodarone (used to treat cardiac arrhythmia), Atropine (often used to regulate the heart), and Dopamine (improves nerve conduction). The area where the crash cart was stored was not locked or secured, was not always visually supervised, and was potentially accessible to unauthorized persons. Additionally, there was an unlocked refrigerator in the alcove just off the entry to the radiology department, which was used to store diazepam (an anti-anxiety). This area was unsecured, not always visually supervised, and was potentially accessible to unauthorized persons.

During interview with RT-B at 11:30 a.m. on 6/13/12, she confirmed the crash cart in the radiology department hallway, and the refrigerator in the alcove, were not always monitored and were potentially accessible to patients and unauthorized persons.

The hospital policy for Storage of Medication dated 11/11, included: "Medications may be stored only in authorized locations...All drugs and biologicals must be secure; ...Generally all drugs should be kept in a locked room or container...All drugs and biologicals must be stored in a manner to prevent access by non-authorized individuals. Persons without legal access to dugs and biologicals cannot have unmonitored access to drugs or biologicals. Persons without legal access to drugs or biologicals cannot have keys to medication storage rooms, carts, cabinets, or containers. Whenever persons without legal access to the drugs or biologicals have unmonitored access to or could gain access to the drugs and biologicals stored in an area, the hospital is not in compliance with the requirement to store all drugs and biologicals in a locked storage area."

The hospital was found out of compliance with the Condition of Participation, Physical Environment (42 CFR 482.41), as evidenced by deficiencies issued as a result of a Life Safety Code inspection completed as a recertification survey.

Findings include:

Refer to Life Safety Code deficiencies - K11, K18, K25, K29, K38, K56, K62, K76, K147, K0011, K0033, and K0147 for additional information.

Based on observation and interview, the hospital failed to ensure hazardous chemicals were kept locked and secured in the soiled utility room of the hospital's emergency department (ED). This had the potential to affect all patients and families who received care in the emergency department.

Findings include:

Chemical cleaning agents located in the ED were being stored in an unlocked area that was not being monitored and were accessible to patients and unauthorized persons.

During a tour of the ED with registered nurse (RN)-A at 2:40 p.m. on 6/11/12, the soiled utility room was observed to be open. The cabinet under the sink in the utility room was unlocked. The cabinet contained: Four spray bottles of disinfectant-A 456, one gallon size container of prolystica neutral detergent concentrate, one gallon size container of prolystica presoak, two quarts metricide, one container QC glass cleaner, one gallon of household bleach, and one bottle of TA-Poff tape remover located in the top unlocked cupboard.

The Material Safety Data Sheets (MSDS) for the A 456 was reviewed and indicated that it could cause eye damage, skin irritation and may be harmful if inhaled or swallowed and cause gastrointestinal corrosion. The MSDS sheets for the prolystica concentrate and pre-soak indicated those products could cause serious eye damage and skin irritation. The MSDS sheet for the metricide indicated it could cause skin irritation, eye damage if there was contact with the eyes, bronchial irritation from inhalation, and the product is toxic if ingested. The MSDS sheet for the QC glass cleaner indicated that it could cause slight irritation to the eyes. The MSDS for the household bleach indicated that it could be corrosive to the eyes, irritate the skin, and cause nausea, vomiting, burning of the mouth and throat if swallowed. The MSDS for the TA-Poff tape remover indicated that it could cause dizziness and a headache if inhaled.

During interview with RN-A at 2:40 p.m. on 6/11/12, she confirmed the hazardous chemicals in the soiled utility room were not locked and the room was not supervised. RN-A verified that patients and unauthorized persons could possibly have access to these products. She also confirmed the ED served a high volume of patients with behavioral health issues.