HospitalInspections.org

Based on observation, interview, and record review the facility failed to have systems in place to ensure outdated drugs are not available for use and there are systems in place to account for all drugs that enter and leave the pharmacy.

Findings:

Observation on 4/25/2013 at 8:40 am on the Medical Surgical unit revealed an opened multi use vial of PPD (purified protein derivative) skin test used to determine an individual's contact with Tuberculosis Bacteria (TB) had a labeled that the vial was opened on 12/2/2012. The medication was stored in the refrigerator that contained medication for current use.

The manufacturer information on the vial instructs that the drug should be discarded thirty (30) days after the vial is opened.

The drug was still in use and was used on 4/1/2013 and on the morning of 4/25/2013,more than ninety ( 90) days after the recommended discard date.

Observation at that time also revealed a multi use vial of Lantus insulin in the refrigerator with information the vial was opened 9/26/2012 was stored with current medication. Manufacturer information instructs the drug is to be discarded twenty eight (28) days after it is opened.

Observation on 4/26/2013 at 9:50 am in the operating room narcotics cupboard revealed Demerol 50 milligrams (mg) was expired since 8/1/2012. The drug was stored with narcotics that were in current use.

During an interview on 4/26/2013 at 11:15 am with Staff (#38) Pharmacist he stated the pharmacy staff was responsible to check all medication areas on the units monthly to ensure medications were current, but it was not done according to their policy.

Observation on 4/25/2013 in the pharmacy at 9:20 am revealed there were no records or systems to track drugs that are not scheduled drugs that enter and leave the pharmacy.

During an interview on 4/25/2013 at 10:05 am with Staff (# 18) Pharmacy Technician she stated all licensed Nurses have access to the pharmacy and it ' s contents after hours. The staffs are required to document what is taken from the pharmacy.

According to Staff (#18) Pharmacy Technician there was no inventory for all drugs that comes in and out of the pharmacy she "just knows when something is missing".

There were no policies developed to ensure an inventory of all medications in and out of the pharmacy.
During an interview on 4/26/2013 at 8:55 am with the Quality Director she stated there are some inadequate policies however, she is in the process of developing adequate policies for each department.

Based on observation interview and record review the facility failed to have updated infection control policies to ensure sterile supplies and medication were not outdated; Failed to ensure patient care equipment, clean linen and prepared food was appropriately stored to prevent sources for infection and communicable diseases.

This failed practice had the potential to adversely affect all staff and patients.

Findings:

Observation on patient care areas on 4/24/2013 between the hours of 1:35 pm and 2:45 pm revealed the following information:

clean linen in multiple storage areas was uncovered.

Random observation on the Medical/Surgical unit revealed mattress covering in rooms 108 and 107 were cracked, stained and or torn in places. The mattress was made of foam encased in a zippered covering. The cracks and tears had the potential for seepage of body fluid in the

Observation in the MRI room revealed wedges used to keep patients in position during a procedure were stored on the floor. There were also several boxes of clean supplies stored on the floor in the Radiology suite.

Observation in Emergency Room two (2) revealed sterile water attached to the oxygen outlet labeled "for respiratory use" was not dated. Staff present was unable to say when the sterile water was placed there.

Observation on 4/25/2013 at 8:40 am on the Medical Surgical unit revealed an opened multi use vial of PPD (purified protein derivative) skin test used to determine an individual's contact with Tuberculosis Bacteria (TB) had a labeled that the vial was opened on 12/2/2012. The medication was stored in the refrigerator that contained medication for current use.

The manufacturer information on the vial instructs that the drug should be discarded thirty (30) days after the vial is opened.

The drug was still in use and was used on 4/1/2013 and on the morning of 4/25/2013,more than ninety ( 90) days after the recommended discard date.

During an interview on 4/26/2013 at 10:00 am with the Respiratory Therapist, she stated the sterile water used for inhalation therapy were for single use only and was not to be opened until time of use.

Review of the facility's infection control policy and plan presented during the survey inspection revealed they were not reviewed and or updated since September 2009.

During an interview on 4/25/2013 at 9:30 am with ( Staff #2) Infection Control Officer she stated the policies and plan is required to be reviewed on an annual basis however it was not done.





12000


Findings:

During Initial tour 4/25/13 at 1:30 p.m. revealed the following:

-Ice Machine in a closet in the hallway. Four ice scoops were observed on top of the machine. The ice scoops were not in a container and were not in a draining position. Dust was observed on door of the ice machine.

-Emergency treatment room #2 had a stretcher with a vinyl mattress. The vinyl mattress had a 2" x 4" tear and someone placed tape over the tear. The overhead operating room light used for suturing had a light dust film on top of the light fixture. Sutures in a drawer were labeled "Chrome Gut 2-0" (six to a box). The expiration date on the box of sutures stated expired January 2012. In drawer were vacutainers as follows: Red tube expired 02/2013; Green tube expired 07/2012 and Blue tube expired 11/2012. In a cart were two penrose rose drains. They penrose drains expired 10/2006. Five Tegaderm dressings expired March 2013. Two nasal sponges expired 01/2013.

-CT X-ray room. Inside an IV tray were six intravenous catheters (18 gauge) that expired October 2011.

-Inside a hall storage cabinet: A Gastric-tube replacement expired October 2010. A Lumbar puncture tray (20 gauge) expired January 2011.

-Inside a cabinet in the nursing station: Iodoform Packing Strip 1" x 5 yards expired June 2011. Iodoform packing strip 1/2" x 5 yards expired September 2010.


32043

During the tour of the kitchen with the Director of food services on 4/25/13, observed in the refrigerator were:
? Three plates of lasagna and corn with the labeled " date-4/21/13 " and " date out - 4/24/13 "
? A small piece of ham in foil wrap dated 4/16/13.
? Few jalapeno peppers in gray colored liquid substance dated 3/14/13.

Interview with the Director of Food Services, she stated that food plates are left in the refrigerator for possible admissions at night, and should be discarded on the specified " date out " . She added that the ham and pepper are only good for seven days and should have been discarded.

During the tour of the Special Care Unit with Staff ID# 5, observed in the crash cart were:
1. An opened packet of two (2) electrodes
2. A packet of adult multi-function electrodes with expiration date 6/2012
3. Two (2) opened laryngoscope blades
4. The base of the cart was brown and sticky with a soft bed restraint which contained greenish mushy substance.

Staff ID# 5 acknowledged the findings, stating that the opened and expired supplies should have been discarded. She explained that the green substance was the original foam padding in the restraint which had disintegrated. She added that nurses are required to check the cart daily.

Based on record review and interview the hospital failed to maintain an employee file for contracted personnel ( Physical Therapist ID# 32 and the Dietician ID# 21)

Findings include:

The Administrator acknowledged 4/24/13 at 1:30 p.m. that Physical Therapy Services and the Dietician were contracted services. The Director of Rehabilitation was physical therapist ID# 32 and the Dietician was ID# 21.

Record review of personnel files revealed no file for physical therapist ID# 32 or the Dietician ID# 21.

The Human Resources Director (ID# 39) acknowledged the hospital did not know they needed to keep a personnel file for contracted personnel.

Record review of a contract for the Physical Therapist dated 12/16/12 stated "Each Physical Therapist provided by physical therapy under this contract is licensed, insured and in compliance with the Texas State Board."