HospitalInspections.org

Based on observation, record review, policy review, and interview, the provider failed to follow the manufacturer's instructions and the policy for the safe storage of intravenous (IV) fluids in one of one fluid warming cabinet. Findings include:

1. Observation on 8/22/23 at 9:00 a.m. of the fluid warmer located in storage room 217 revealed:
*The temperature on the fluid warmer was 110 degrees Fahrenheit (F).
*There were two 1000 milliliter bags of 0.9 Sodium Chloride injection and two 1000 milliliter Lactated Ringers injection for patient use stored in the fluid warmer.

Review of the Fluid Warmer Temperature Log from 8/1/23 through 8/22/23 revealed:
*Temperatures were recorded twice per day by the nursing staff.
*Every temperature recorded was 110 degrees F.

Review of the 6/29/20 provider policy "Warmers for Fluids Irrigations and Blankets- Enterprise" revealed:
*"Purpose: To provide guidelines for the storage conditions of intravenous solutions and /or irrigation solutions in fluid warmers."
*"Policy: Fluid Warmers- When the use of warmed IV [intravenous] solutions and/or irrigating solutions is clinically indicated, medically necessary or desirable, the manufacturer's storage recommendations are followed (unless safety and efficacy outside manufacturer's recommendations have been documented with evidence-based guidelines)."
*"Procedure: Fluid Warmers
1. Solutions for injection and irrigation should not come into direct contact with the heating element in the warmer.
2. Unless manufacturer instructions indicate otherwise; solution containers should remain in the warmer for no longer then 28 days at a temperature not to exceed 104 F (40C).
a. When a bag or bottle is placed in the warmer, the date that the solution will expire is recorded on the container.
b. If solution is not used by the expiration date it is discarded.
c. Solutions are not re-warmed. If a solution is removed from the warmer and it is not used, it should be discarded.
d. If warmer temperature exceeds 104 F, discard fluids.
3. Temperature is monitored continuously."

Interview on 8/22/23 at 9:35 a.m. with director of nursing B revealed:
*She had reviewed the manufacturer's instructions for the storage of the two types of IV fluids. Both fluids were to have been stored below 104 F.
*She confirmed they were not following the manufacturer's instructions or their policy for the safe storage of IV fluids.