The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

TRI COUNTY HOSPITAL - WILLISTON 125 SW 7TH ST WILLISTON, FL June 22, 2011
VIOLATION: RESPIRATORY CARE SERVICES POLICIES Tag No: A1160
Based on record review, interview and observation, the facility failed to have a viable system in place to ensure the equipment on the adult and pediatric crash carts were within the recommended manufacturer's recommended usage dates.

Findings:

It was also observed on the Medical Surgical (Med. Surg) Unit on 6-22-11 at 12:41 PM, that the Pediatric Emergency Box, the batteries for the laryngoscope were oozing a brownish fluid and would not work. On the Pediatric Crash Cart the following Endotracheal Tubes were out-of-date:
Sizes: 4.0 Out-of-date 3/10
4.5 (2) Out-of-date 10/07
5.0 (2) Out-of-date 1/07
6.0 Out-of-date 7/10
Trach Tube Guide Out-of-date 2005

On the Adult Crash Cart the following Endotracheal Tubes were expired:
Sizes: 8.5 Out-of-date 11/10
8.0 (2) Out-of-date 11/09
7.5 Out-of-date 9/08
7.0 Out-of-date 10/10
7.5 Out-of-date 11/10
6.5 (2) Out-of-date 4/10
Looped Suction Catheter Out-of-date 4/05

In interview with the Director of Nursing, on 6-22-11, it was stated that the carts are checked daily and a sign off sheet is kept with the carts.

Review of the Crash Cart/Defibrillator sign-off sheet revealed that everyone who did sign the form acknowledged the expired items as 5/1/11 in April and May 2011 on both the 7 AM - 7 PM and the 7 PM - 7 AM shifts.

Review of the facility's record failed to reveal any policy to ensure that equipment on the adult and pediatric crash carts were within the recommended manufacturer's recommended usage dates.
VIOLATION: UNUSABLE DRUGS NOT USED Tag No: A0505
Based on observation and interview, the facility failed to ensure that the medications readily available in the emergency room were within the manufacturer's recommended usage period.

Findings:

During the facility tour of the Emergency Department (ED), on 6-22-11 at 12:45 PM it was discovered that the following medications were expired and were readily available for use:
Pedialyte Cherry Flavored Electrolyte Oral Supplement. (Six Bottles) Out-of-date: 11/10
Novolin N Insulin, 30 ML Bottle - Out-of-date: 4/11
Etomidate 10 MG/10 ML. (9 Vials) Out-of-date 5/11
Dopamine 1600 Mcg/ML in 5% Dextrose (500 ML IV Fluid Bag) Out-of-date: 3-1-11

In interview with the ED Nurse on 6-22-11 at 12:45 PM, it was stated that they accept patients from the local pediatrician. It was further stated that the expired medications were over-looked as the ED had been busy during the last few weeks.
VIOLATION: FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE Tag No: A0724
Based on observation and interview and record review, the facility failed to maintain the medications in the Emergency Department and Medical Surgical (Med Surge) Unit equipment in a safe manner and/or operating condition.

Findings:

During the facility tour of the Emergency Department (ED), on 6-22-11 at 12:41 PM, it was discovered that the following medications were expired and were readily available for use:
Pedialyte Cherry Flavored Electrolyte Oral Supplement. (Six Bottles) Out-of-date: 11/10
Novolin N Insulin, 30 ML Bottle - Out-of-date: 4/11
Etomidate 10 MG/10 ML. (9 Vials) Out-of-date 5/11
Dopamine 1600 Mcg/ML in 5% Dextrose (500 ML IV Fluid Bag) Out-of-date: 3-1-11

It was also observed on the Med. Surge Unit that the Pediatric Emergency Box, the batteries for the laryngoscope were oozing a brownish fluid and would not work. On the Pediatric Crash Cart the following Endotracheal Tubes were out-of-date:
Sizes: 4.0 Out-of-date 3/10
4.5 (2) Out-of-date 10/07
5.0 (2) Out-of-date 1/07
6.0 Out-of-date 7/10
Trach Tube Guide Out-of-date 2005

On the Adult Crash Cart the following Endotracheal Tubes were expired:
Sizes: 8.5 Out-of-date 11/10
8.0 (2) Out-of-date 11/09
7.5 Out-of-date 9/08
7.0 Out-of-date 10/10
7.5 Out-of-date 11/10
6.5 (2) Out-of-date 4/10
Looped Suction Catheter Out-of-date 4/05

In interview with the Director of Nursing, on 6-22-11 it was stated that the carts are checked daily and a sign off sheet is kept with the carts.