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.
| MONUMENT HEALTH RAPID CITY HOSPITAL | 353 FAIRMONT BLVD POST OFFICE BOX 6000 RAPID CITY, SD 57701 | Sept. 15, 2011 |
| VIOLATION: PATIENT RIGHTS | Tag No: A0115 | |
| Based on observation, interview, record review, and policy review, the provider failed to ensure patient rights for safe and accurate care were followed for one of five patients (1) reviewed for patient rights and nursing services by: *Not restricting access to saline flush syringes to unauthorized personnel. *Not following a physician's order to discontinue intravenous (IV) fluids. *Not reconciling two different admission/discharge medication history and order forms, so all home medications were accurately ordered/administered. Findings include: 1. Review of an undated final report of patient death resulting from other than natural causes originating on facility property for patient 1 received by the South Dakota Department of Health revealed: *On 9/4/11 at 9:15 p.m. the patient had been found unresponsive in his bed. *A nurse was called and found the patient without a pulse and respirations. *The patient was revived by the rapid response team and transferred to another unit. *The patient remained unresponsive and died two days later after life support had been removed. *At the above time a syringe was attached to the patient's peripherally inserted central catheter (PICC). *A patient care technician found empty syringes on the floor under the patient's bed. *The patient's belongings included a small plastic bag containing an opaque white liquid substance. *The police tested the contents of the above bag and found it contained oxycodone and acetaminophen. *A hospital coordinator reported after the above incident a friend of patient 1 had told her the patient had been crushing his pills and injecting them into his PICC. Interview on 9/13/11 at 3:45 p.m. with the director of risk management revealed: *There were 10 milliliter (ml) saline flush syringes stored in a wound care tray in patient 1's room. *Visitors in the room would have had access to the saline flush syringes in the wound care tray. *After personnel used the saline flush syringes there was no standard way for disposal. Either the waste basket or sharps container were used to dispose of the saline flush syringes. *The same 10 ml saline flush syringes could have been used by nurses to flush the PICC and IV lines. *The provider used a needleless system where the saline flush syringes could have been attached to the PICC or IV line. *Patient 1 would have been able to hold the IV line and the first port of the line in his hand if he had attempted to attach a syringe to the line. *The syringe found on 9/4/11 at 9:15 p.m. attached to patient 1's PICC/IV line was a saline flush syringe. Refer to A144, finding 1. 2. Review of patient 1's physician's progress notes dated 8/29/11 at 10:20 p.m. revealed a plan that included: *Changing the PICC line to the left side. *Discontinuing IV fluids. Review of patient 1's physician's orders dated 8/29/11 at 11:00 a.m. revealed patient 1's: *PICC location was to have been changed to his left side. *IV fluids were to be discontinued. Review of patient 1's supply records for the unit where he was located revealed from 8/30/11 at 5:28 a.m. and 9/4/11 at 12:57 p.m. sodium chloride solution was removed from the unit four times for a total of 2500 ml. Interview on 9/14/11 at 3:30 p.m. with hospitalist F revealed: *He had written the order on 8/29/11 for the patient 1's IV solution to be discontinued. *He was not aware there were IVs running after the location of the PICC had been changed. Refer to A392, finding 1. 3. Review of patient 1's medical records revealed: *He had been transferred from the emergency room to his hospital room on 8/17/11 at 6:40 a.m. *He had two different admission/discharge medication history and order forms prepared listing home medications. *The first listing included five medications and the second listing included eight. *The three medications not included on the first listing were Prozac, oxcarbazepine, and dantrolene. *The first listing had been faxed to the pharmacy to obtain medications for administration to patient 1. *There were two separate requests from nursing staff to patient 1 ' s hospitalists to review/order the medications not included on the first listing. Neither of those requests was acted on. Review of patient 1's electronic medication record revealed from 8/17/11 through 9/4/11 he was never administered Prozac, oxcarbazepine, or dantrolene. Refer to A500, finding 1. |
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| VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING | Tag No: A0144 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, policy review, and training review, the provider failed to ensure nursing services were provided in a safe manner by ensuring: *Saline flush syringes were stored to prevent patient or visitor access for one of five patients (1) reviewed for patient rights and nursing services. *Supplies were stored safely for one of three observed patients (2). *Proper techniques were used for two of three observed patients (2 and 3) receiving patient care. Findings include: 1. Review of patient 1's admitting medical record revealed he had: *Been admitted on [DATE]. *Paralysis affecting the lower half of the body and both legs resulting in chronic pain. *A fever. *A urinary tract infection. *An abscess at the base of the spine resulting in pain. *A peripherally inserted central catheter (PICC) for administration of intravenous (IV) antibiotic solutions. Review of an undated final report of patient death resulting from other than natural causes originating on facility property for patient 1 received by the South Dakota Department of Health revealed: *On 9/4/11 at 9:15 p.m. the patient had been found unresponsive in his bed. *A nurse was called and found the patient without a pulse and respirations. *The patient was revived by the rapid response team (RRT) and transferred to another unit. *The patient remained unresponsive and died two days later after life support had been removed. *At the above time a syringe was attached to the patient's PICC. *A patient care technician found empty syringes on the floor under the patient's bed. *The patient's belongings included a small plastic bag containing an opaque white liquid substance. *The police tested the contents of the above bag and found it contained oxycodone and acetaminophen. *A hospital coordinator reported after the above incident a friend of patient 1 had told her the patient had been crushing his pills and injecting them into his PICC. Interview on 9/13/11 at 3:45 p.m. with the director of risk management revealed: *There were 10 milliliter (ml) saline flush syringes stored in a wound care tray in patient 1's room. *The wound care tray was not located during dressing changes in a position where patient 1 could have had access to it. *The wound care tray was stored on a shelf where patient 1 could not have had access to it. *Visitors in the room would have had access to the saline flush syringes in the wound care tray. *After personnel used the saline flush syringes there was no standard way for disposal. Either the waste basket or sharps container were used to dispose of the saline flush syringes. *The same 10 ml saline flush syringes could have been used by nurses to flush the PICC and IV lines. *The provider used a needleless system where the saline flush syringes could have been attached to the PICC or IV line. *Patient 1 would have been able to hold the IV line and the first port of the line in his hand if he had attempted to attach a syringe to the line. *It would have been more difficult for patient 1 to attach a syringe to the PICC, because it would have been away from his hand. *It would have required some physical dexterity for patient 1 to attach a saline flush syringe to either the PICC or IV line. *If pressure was applied to an improperly attached saline flush syringe the syringe could have popped off. *The syringe found on 9/4/11 at 9:15 p.m. attached to patient 1's PICC/IV line was a saline flush syringe. Review of patient 1's electronic medication record revealed from 8/18/11 through 9/4/11 he was administered a total of 70 doses oxycodone/acetaminophen (Percocet). On 9/4/11 he had been administered Percocet 4 times for a total of 8 doses. The last administration was at 8:25 p.m. on 9/14/11. Telephone interview on 9/14/11 with patient care technician (PCT) G revealed: *She had worked on 9/4/11 from 2:00 p.m. to 10:30 p.m. *Around supper time a man and woman with two young children were in patient 1's room. The patient had seemed to be in good spirits at that time. *Some time in the evening patient 1 had asked for something for pain and she had relayed the request to registered nurse (RN) D. RN D then had administered Percocet to the patient. *At approximately 8:45 p.m. she had peeked around the curtain in patient 1's room and found a visitor present. She left the room. *After the visitor had left the room she returned to the room to provide evening care for patient 1. The patient opened his eyes but did not speak. The room was cluttered with chairs by the bed. She had straightened things and found two empty saline flush syringes on the floor under the bed. She threw those syringes in the trash. She also straightened items in the drawer of the patient's bedside stand to find his toothbrush. *She had attempted to awaken the patient by: - Calling his name, and he did not stir. - Shaking him and he did not respond. - Doing a sternal rub and he had no response. *She then called for RN D to come to the room. Review of a nursing note prepared by RN D on 9/5/11 at 1:20 a.m. revealed: *She had administered Percocet to patient 1 at 10:30 p.m. *She had observed the patient taking the Percocet. *At approximately 9:15 p.m. PCT G reported the patient would not "wake up." *She went to assess the patient and noted a syringe was attached to the IV line. *The syringe appeared to have a white powder in it. *She was unable to get a response from the patient. *Vital signs were checked by a machine and were absent. *The rapid response team (RRT) was called at 9:28 p.m. Interview on 9/15/11 at 10:30 a.m. with RN D revealed: *On 9/4/11 her shift was from 3:00 p.m.. to 11:30 p.m. *After she was called in to patient 1's room by PCT G she pulled the blanket back. She then saw a syringe connected to the port on the IV tubing that was closest to the PICC. *Normal saline IV solution was running, because patient 1 had requested it to continue. That was done because the patient had requested to be involved in his care. *She removed the syringe from the IV tubing. Review of a nursing note prepared by RN E on 9/5/11 at 7:43 a.m. revealed: *PCT G had reported seeing empty syringes under patient 1's bed prior to the RRT being called to the room. *A small plastic bag with an unidentified opaque liquid substance was removed from patient 1's bedside stand when the patient had been transferred to another room. *The syringe and plastic bag had been placed in a locked box by RN E and the hospital coordinator. *The hospital coordinator reported a family member had told her patient 1 had a history of self-administering medication through the PICC. Interview on 9/15/11 at 8:05 a.m. with RN E revealed: *She came to patient 1's room from another floor when the RRT had been called. *By the time she had arrived the syringe had been removed from the IV tubing. *She and the hospital coordinator packed up patient 1's belongings and found the plastic bag containing the opaque white substance. *She and the hospital coordinator found ten saline flush syringes in the wound care tray. One of the syringes was empty, and one was partially full. It was not the normal practice for any used syringes to have been placed back into the wound care tray. Those two syringes had been thrown into the trash. 2. Observation at 1:00 p.m. on 9/13/11 of patient 2's right hand dressing change revealed RN A obtained dressing supplies from a plastic bin. That bin was stored on the sink counter with at least one fourth of the bin blocking the sink basin. Interview with RN A at 1:10 p.m. on 9/13/11 revealed he agreed the above supplies in the bin were not stored appropriately. He confirmed the positioning of that bin would have made it difficult for him to wash his hands without contaminating the dressing supplies. He stated he would move that bin of supplies to a different location. Interview at 9:30 a.m. on 9/14/11 with the infection prevention and control (IPC) director and assistant director revealed patient care supplies were to have been stored away from any area of possible contamination. They confirmed storage of the bin on the sink counter and over the sink was not an appropriate storage option. Interview at 10:15 a.m. on 9/14/11 with the IPC director revealed she had observed the bin of supplies was still stored by and over the sink in patient 2's room. She stated she had staff move the supply bin immediately to safer storage. Review of the provider's undated online annual safety training revealed handwashing should have been done immediately following contact with any potential bloodborne germs. Review of that training also revealed handwashing facilities should have been readily accessible. 3. Observation from 2:05 p.m. to 2:30 p.m. on 9/13/11 revealed patient 3 was being prepared for a dressing change on her post-surgical wounds. Observation revealed RN C was already gloved and gowned as this surveyor entered the room. With those gloved hands RN C: *Removed the soiled dressing from patient 3's back. *Used a syringe to draw up normal saline to flush the open wound. *Touched patient 3's side rail and sheet with those soiled gloves. At that time RN C removed her soiled gloves. Without washing her hands or using alcohol-based hand foam she applied a new pair of gloves. With those gloved hands she: *Opened dressing materials. *Applied barrier cream around the wound edges. *Placed the dressing material to soak in normal saline. *Removed the saline-soaked dressing and wrung out the excess liquid. *Applied the saline-soaked gauze into patient 3's open wound. *Placed a dressing cover over the wound. *Removed the soiled underpad and dressing materials. At that time RN C removed her soiled gloves. Without washing her hands or using alcohol-based hand foam she applied a new pair of gloves. During the course of the above dressing change, observation revealed patient 3 had a loose, incontinent bowel movement. Patient 3 also had an indwelling Foley urinary catheter. While cleaning patient 3, RN B applied gloves and wiped the incontinent stool from the patient's bottom. After wiping away that stool she removed her soiled gloves. Without washing her hands or using alcohol-based foam cleanser RN B applied a new pair of gloves. With those gloved hands she: *Wiped barrier cream on patient 3's bottom. *Used a disposable cleansing washcloth to clean the cream from her gloves. *Rolled the soiled linens under patient 3. *Applied clean linens to patient 3's bed. *Rolled patient 3 on her other side now facing her. *Touched patient 3's hand to steady it on the raised side rail. *Cleaned incontinent stool from the front of patient 3's legs. *Wiped from back to front across patient 3's indwelling catheter. Three disposable cleansing washcloths were used to clean that area wiping across the catheter insertion site each time. After cleaning that area RN B removed her soiled gloves. Without washing her hands or using alcohol-based foam cleanser RN B applied a new pair of gloves. Observation at the above same time revealed RN C with gloved hands pulled the soiled linens from underneath patient 3. With those same gloved hands she secured the clean linens on patient 3's bed. Interview at 2:35 p.m. on 9/13/11 with the unit coordinator and assistant unit coordinator revealed all staff had been instructed regarding the need to wash hands or use alcohol based hand foam between glove changes. Further interview revealed it was their expectation all nurses should know about appropriate cleaning around a catheter site. Interview at 9:30 a.m. on 9/14/11 with the IPC director and assistant director revealed all staff had been instructed in appropriate glove use, hand hygiene, and catheter care. They confirmed the above care did not meet the provider's standards. Review of the provider's revised January 2008 hand hygiene policy revealed hands should have been cleaned after removing gloves. Review of the provider's revised August 2009 contact precautions policy revealed gloves were to have been changed after contact with infective material. Review of the provider's revised August 2008 transmission of microorganisms policy revealed: *Microorganisms could have been transmitted by direct or indirect contact. *Direct contact was defined as person-to-person contact between hospital personnel and patients. *Indirect contact was defined as contact between an individual and another contaminated object such as bed linens or dressings. Review of the provider's undated online infection control and patient safety training revealed: *Hand hygiene should have been performed after removing protective gloves. *The control measures for multi-drug resistant organisms included consistent hand hygiene with appropriate glove use. Interview beginning at 9:30 a.m. on 9/14/11 with the IPC director and assistant director revealed the provider was involved in a program for the prevention of catheter-associated urinary tract infections. Review of the criteria associated with that program was the need for proper maintenance of the catheter. That maintenance included the need for good handwashing before and after handling a catheter. Interview at 10:30 a.m. on 9/15/11 with the director of risk management revealed the provider did not have a policy specific to cleaning patients after having an incontinent stool. She stated staff followed the standard of nursing practice that included wiping the perineal area from front to back. She stated no competencies were completed for nurses on basic nursing practice. |
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| VIOLATION: NURSING SERVICES | Tag No: A0385 | |
| Based on observation, interview, record review, and policy review, the provider failed to ensure nursing services were offered by using established policies/procedures or following a physician ' s order for one of five patients (1) reviewed for patient rights and nursing services by: *Not restricting unauthorized personnel from access to saline flush syringes . *Not following a physician's order to discontinue intravenous (IV) fluids. *Not reconciling two different admission/discharge medication history and order forms so all home medications were accurately ordered/administered. Findings include: 1. Review of an undated final report of patient death resulting from other than natural causes originating on facility property for patient 1 received by the South Dakota Department of Health revealed: *On 9/4/11 at 9:15 p.m. the patient had been found unresponsive in his bed. *A nurse was called and found the patient without a pulse and respirations. *The patient was revived by the rapid response team and transferred to another unit. *The patient remained unresponsive and died two days later after life support had been removed. *At the above time a syringe was attached to the patient's peripherally inserted central catheter (PICC). *A patient care technician found empty syringes on the floor under the patient's bed. *The patient's belongings included a small plastic bag containing an opaque white liquid substance. *The police tested the contents of the above bag and found it contained oxycodone and acetaminophen. *A hospital coordinator reported after the above incident a friend of patient 1 had told her the patient had been crushing his pills and injecting them into his PICC. Interview on 9/13/11 at 3:45 p.m. with the director of risk management revealed: *There were 10 milliliter (ml) saline flush syringes stored in a wound care tray in patient 1's room. *Visitors in the room would have had access to the saline flush syringes in the wound care tray. *After personnel used the saline flush syringes there was no standard way for disposal. Either the waste basket or sharps container were used to dispose of the saline flush syringes. *The same 10 ml saline flush syringes could have been used by nurses to flush the PICC and IV lines. *The provider used a needleless system where the saline flush syringes could have been attached to the PICC or IV line. *Patient 1 would have been able to hold the IV line and the first port of the line in his hand if he had attempted to attach a syringe to the line. *The syringe found on 9/4/11 at 9:15 p.m. attached to patient 1's PICC/IV line was a saline flush syringe. Refer to A144, finding 1. 2. Review of patient 1's progress notes dated 8/29/11 at 10:20 p.m. revealed a plan that included: *Changing the PICC line to the left side. *Discontinuing IV fluids. Review of patient 1's physician's orders revealed an order dated 8/29/11 at 11:00 a.m. revealed: *The PICC location was to have been changed to his left side. *IV fluids were to be discontinued. Review of patient 1's supply records for the unit where he was located revealed from 8/30/11 at 5:28 a.m. to 9/4/11 at 12:57 p.m. sodium chloride solution was removed from the unit four times for a total of 2500 ml. Interview on 9/14/11 at 3:30 p.m. with hospitalist F revealed: *He had written the order on 8/29/11 for the patient 1's IV solution to be discontinued. *He was not aware there were IVs running after the location of the PICC had been changed. Interview on 9/15/11 at 10:30 a.m. with RN D revealed: *Normal saline IV solution was running at the time patient 1 was found unresponsive, because he had requested it be continued. That was done because the patient had requested to be involved in his care. Refer to A392, finding 1. 3. Review of patient 1's medical records revealed: *He had been transferred from the emergency room to his hospital room on 8/17/11 at 6:40 a.m. *He had two different admission/discharge medication history and order forms prepared listing home medications. *The first listing included five medications and the second listing included eight. *The three medications not included on the first listing were Prozac, oxcarbazepine, and dantrolene. *The first listing had been faxed to the pharmacy to obtain medications for administration to patient 1. *There were two separate requests from nursing staff to the hospitalists to review/order the medications not included on the first listing. Neither of those requests had been acted on. Review of patient 1's electronic medication record revealed from 8/17/11 through 9/4/11 he was never administered Prozac, oxcarbazepine, or dantrolene. Interview on 9/15/11 at 11:20 a.m. with the vice president for quality, safety, and risk revealed: *Medication reconciliation was taught at new employee orientation. *The process was for the nurse to complete the admission/discharge medication history and order (form). *The form was supposed to be given to the physician. *If there were mistakes on the original form the process was not to prepare a new form. The physician should have been informed of the mistakes. *The provider did not have a policy on how to complete and use the form. Refer to A500, finding 1. |
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| VIOLATION: STAFFING AND DELIVERY OF CARE | Tag No: A0392 | |
| Based on observation, interview, and record review, the provider failed to ensure a physician's order to discontinue intravenous (IV) fluids was followed for one of five patients (1) reviewed for patient rights and nursing services. Findings include: 1. Review of patient 1's progress notes dated 8/29/11 at 10:20 p.m. revealed a plan that included: *Changing the peripherally inserted central catheter (PICC) line to the left side. *Discontinuing intravenous (IV) fluids. Review of patient 1's physician's orders revealed an order dated 8/29/11 at 11:00 a.m. revealed patient 1's: *PICC was to be removed and the tip sent for culture. *PICC location was to have been changed to his left side. *IV fluids were to be discontinued. Review of patient 1's supply records for the unit where he was located revealed: *A 500 milliliter (ml) bag of sodium chloride solution was withdrawn from stock on 8/30/11 at 5:28 a.m. *A 500 ml bag of sodium chloride solution was withdrawn from stock on 9/1/11 at 3:43 a.m. *A 500 ml bag of sodium chloride solution was withdrawn from stock on 9/3/11 at 3:43 a.m. *A 1000 ml bag of sodium chloride solution was withdrawn from stock on 9/4/11 at 12:57 p.m. Interview on 9/14/11 at 3:30 p.m. with hospitalist F revealed: *He had written the order on 8/29/11 for the patient's IV solution to be discontinued. *He was not aware there were IVs running after the location of the PICC had been changed. Interview on 9/15/11 at 10:30 a.m. with RN D revealed: *She had found patient 1 in an unresponsive state on 9/4/11 at 9:15 p.m. *At that time she saw a syringe connected to the port on the IV tubing that was closest to the PICC. *Normal saline IV solution was running because patient 1 had requested it be continued. That was done because the patient had requested to be involved in his care. Refer to A144. |
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| VIOLATION: DELIVERY OF DRUGS | Tag No: A0500 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy review, the provider failed to ensure there was an accurate and complete medication reconciliation process for one of five patients (1) reviewed for patient rights and nursing services. Findings include: 1. Review of patient 1's medical records revealed he: *Had been admitted on [DATE] at 4:27 a.m. *Had been transferred from the emergency room to his hospital room on 8/17/11 at 6:40 a.m. *Had an admission/discharge medication history and order form prepared by an unknown person at an unknown time listing five different home medications (morphine 15 milligram (mg), Percocet 5 mg/325 mg, Lyrica 75 mg, Detrol 4 mg, and Baclofen 20 mg). The above form was signed by a physician on 8/17/11 at 6:55 a.m. The form was marked as faxed. *Had an admission/discharge medication history and order form prepared by a registered nurse (RN) on 8/17/11 at 7:30 a.m. listing nine different home medications (Prozac 20 mg/2 capsules, Bactroban ointment, oxcarbazepine 600 mg, dantrolene 25 mg/3 capsules, Baclofen 20 mg, Detrol LA 4 mg, morphine 15 mg, Lyrica 75 mg, and Percocet 5 mg/325 mg). The above form was not signed by a physician and was not marked as faxed. Review of an undated interdisciplinary physician communication addressed to the hospitalist included the comment, "Found admission medication history form from August 17 with Prozac and oxcarbazepine not ordered. Would you like to order these? Please advise." There was no physician response included on the form. The same form also included a comment to the hospitalist dated 8/27/11 at 9:58 a.m. asking if continuous pulse oxygen readings could have been discontinued. That request was responded to by the physician. Review of an interdisciplinary physician communication dated 9/2/11 at 9:15 p.m. and signed by RN D addressed to the hospitalist included the comment, "Please address home medications that have not been addressed yet, such as Prozac, oxcarbazepine, and dantrolene. There are two separate medication lists." There was no physician response included on the form. Review of patient 1's medical staff progress notes from 8/25/11 through 9/4/11 revealed there were no comments related to the above interdisciplinary physician communications or any comments about the mentioned medications. Review of patient 1's electronic medication record revealed from 8/17/11 through 9/4/11 he was never administered Prozac, oxcarbazepine, or dantrolene. Interview on 9/15/11 at 8:05 a.m. with RN E revealed: *She had found out about the the Prozac after she had a discussion with RN D on the evening of 9/2/11 after RN D had prepared the form. *She had spoken about the Prozac with a nurse practitioner and had been informed the nurse practitioner would have checked on it. *She did not know if the Prozac had been reordered or not. Interview on 9/15/11 at 11:20 a.m. with the vice president for quality, safety, and risk revealed: *Medication reconciliation was taught at new employee orientation. *The process was for the nurse to complete the admission/discharge medication history and order (form). *The form was supposed to be given to the physician. *If there were mistakes on the original form the process was not to prepare a new form. The physician should have been informed of the mistakes. *The provider did not have a policy on how to complete and use the form. *The provider had used an educational poster to inform staff about the process to use the form. *She acknowledged the second form in patient 1's medical record had not been addressed. Interview on 9/15/11 at 1:30 p.m. with the director of risk management revealed: *There was no particular procedure for use of the form. *Nurses were supposed to complete the forms and place them in the patients' records. *The forms replaced sticky notes that had previously been used. *There was no particular process to ensure information on the forms were acted on. Review of Charles F. Lacy, et al, Drug Information Handbook, 18th Edition, Lexi-Comp, 2009-2010, revealed: *Page 638, Prozac was listed in the pharmacologic category as an antidepressant. *Page 1116, Oxcarbazepine was listed in the pharmacologic category as an anticonvulsant. *Page 395, Dantrolene was listed in the pharmacologic category as a skeletal muscle relaxant. |
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