HospitalInspections.org

Based on document review, observation and interview, it was determined for 1 of 1 crash cart in the special care nursery unit and 1 of 1 crash cart on the labor and delivery (L&D) unit, the Hospital failed to ensure the emergency carts were equipped and readily available for use. This potentially affected all 3 infants and 2 adults on census 5/28/13.

Findings include:

1. The Hospital's , policy titled, "emergency crash cart-locations and checking/maintenance" (8/6/05), required, ...2. check crash cart at the beginning of every shift...resuscitation equipment must be maintained to be ready for immediate use...7. ...every 15th and 30th or last day of the month...check supplies and equipment for expiration date and supply replacement if needed."

2. On 5/28/13 at approximate 9:00 am, the crash cart checklists for January through May 2013 were reviewed. The checklist lacked documentation of the crash cart check on various occasions. Examples include:
-January 2013: 1/3, 1/4, 1/7, 1/22, 1/26, 1/27, 1/30, and 1/31 am shift.

-February 2013: 2/1, 2/12, 2 2/22, 2/23, 2/24, and 2/26 am shift 2/10, 2/27 thru 2/28 am pm shift.

-March 2013: 3/1, 3/4, 3/7, 3/9, thru 3/11, 3/15, 319, 3/20, 3/23, 3/24, 3/26, 3/27, and 3/31 am shift; and 3/4, 3/17 and 3/22 pm shift.

-April 2013: 4/1 thru 4/6, 4/8, 4/26, 4/30, and 4/31 am shift.

-May 2013: 5/27 am shift.

3. On 3/28/13 the crash cart in the L&D unit, drawer #5 was checked. The list of supplies on the front of the drawer required the drawer to contain, in part: 1 each laryngoscope blades: #3 miller straight, #3 macintosh curved, and #3 macintosh curved. The drawer lacked any laryngoscope blades.

4. On 5/28/13 at approximately 10:00 am the crash cart in the special care nursery was checked. A list of supplies on the front of the drawer required the drawer to contain various intubation equipment. The drawer lacked laryngoscopes.

5. On 5/28/13 at approximately 9:15 am during the inspection of the crash cart, E#4 confirmed these findings.