HospitalInspections.org

Based on observation, staff interview, and policy review the Critical Access Hospital (CAH) failed to follow professional guidelines for stocking the emergency medication Dantrium/Revonto when succinylcholine (a medication used to relax the muscles during surgical procedures) is used at the facility (refer to C-0202). Failure to have Dantrium/Revonto could cause patient harm or death in the event of Malignant Hyperthermia (a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia - specifically the volatile anesthetic agents and succinylcholine, a neuromuscular blocking agent).

An Immediate Jeopardy (IJ) (a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient) was identified on 1/18/2017 at 12:15 PM and the administrative staff notified. The administrator, having an alternative paralytic for use, immediately suspended the use of succinylcholine until the reversal agent Dantrium/Revonto could be obtained. The administrator also suspended all Surgical Services and Labor and Delivery Services patient traffic through the Emergency Department.

The facility removed the Immediate Jeopardy when the required amount of the reversal agent Dantrium/Revonto was delivered at 2:55 PM on 1/18/2017 prior to the survey exit date.

Based on observations, interview, and policy review, the Critical Access Hospital (CAH) failed to ensure the emergency medication (Dantrolene/Revonto) was readily available in the emergency department (ED) by failing to have the medication on hand to treat Malignant Hyperthermia (a rare life-threatening condition causing a severe high body temperature triggered by medications that act as depolarizing muscle relaxants such as succinylcholine (a muscle relaxant administered in the ED when breathing is compromised) and a patient requires intubation (passing of a tube into the airway to establish the ability to breath). Failure to have enough Dantrolene/Revonto immediately available for use had the potential for delays in responding to a medical emergency causing a worsening of a patient's condition or death.


Findings Include:

- Emergency Department tour conducted between 10:30 and 12:15 PM revealed a medication, Succinylcholine, available for use without the necessary emergency medications and supplies to treat its potentially fatal adverse side effect-Malignant Hyperthermia. The Malignant Hyperthermia (MH) Cart revealed the facility only had 23 (20 milligram vials) of the required 36 (20 milligram vials) of Dantrium/Revonto (medication used to treat MH) available for use.

Risk Manager Staff D interviewed on 1/18/2017 at 12:20 PM confirmed with pharmacy staff and surgical staff that only 23 vials of Dantrolene/Revonto were in stock and available for use. Staff D indicated seven vials expired on 12/31/2016 and were scheduled for delivery via Federal Express on 1/19/2017 by 2:30 PM. Staff D revealed the medication had been identified as expired on 1/13/2017 by surgical staff and ordered on 1/16/2017 by pharmacy staff.

Administrative Staff A interviewed on 1/18/2017 at 12:25 PM acknowledged the facilities lack of the required 36 vials of Dantrium/Revonto and indicated the facility would immediately discontinue using succinylcholine for intubations, surgical services, obstetrical services, and emergency services until the proper amount of medication arrived and was verified.

- Pharmacy Staff K arrived at the facility at 2:55 PM with 14 additional vials of Dantrium/Revonto. A total count of 37 vials of Dantrolene/Revonto was confirmed at this time.

Document titled "Malignant Hyperthermia Stock and Supplies" reviewed on 1/18/2017 at 2:45 PM directed "... Dantrium (Dantrolene) 20mg - 6 boxes (36 vials) and/or Ryanodex (alternative medication used fro treating Malignant Hyperthermia) equivalent to 720 mg of Dantrium..."