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Based on observation, manufacturer label review, and interview, the facility failed to ensure a method was in place to reflect how long Succinylcholine Injectable and Rocuronium Bromide Injectable were stored at room temperature once removed from refrigeration so that potency of the medications be maintained. In addition, the facility failed to ensure the medications were not available for patient use. The deficient practice affected the storage of Succinylcholine Injectable on two of three anesthesia carts and the storage of Rocuronium Bromide one of three anesthesia carts. An average monthly census of 45 patients undergoing surgeries/procedures had the potential to receive the medications if ordered. Findings follow:

A. Two anesthesia carts were observed to contain one vial of Succinylcholine Injectable each stored at room temperature. The observation was made on 06/08/11 between 1300 and 1330. There was no evidence when the Succinylcholine Injectable was removed from refrigeration.
B. One anesthesia cart was observed to contain two vials of Rocuronium Bromide Injectable stored at room temperature. The observation was made on 06/08/11 between 1300 and 1330. There was no evidence when the Rocuronium Bromide Injectable was removed from refrigeration.
C. The manufacturer labels for both medications were reviewed on 06/08/11 at 1335. The manufacturer information for Succinylcholine Injectable reflected the medication could only be stored at room temperature for 14 days once removed from refrigeration. The manufacturer information for Rocuronium Bromide Injectable reflected the medication could be stored for 60 days if the vial was unopened or 30 days if opened.
D. Certified Registered Nurse Anesthetist #1 verified through interview on 06/08/11 at 1500 there was no method in place in which staff could identify how long Succinylcholine Injectable and Rocuronium Bromide Injectable had been stored at room temperature on the anesthesia carts and the medications were available for patient use.

Based on observation, manufacturer label review, and interview, the facility failed to ensure Famotidine Injectable was not stored at room temperature on two of three anesthesia carts. The facility also failed to ensure Famotidine Injectable stored at room temperature was not available for patient use. The potential existed for an average monthly census of 45 surgery patients to receive the Famotidine if ordered. Findings follow:

A. Two anesthesia carts were observed on 06/08/11 between 1300 and 1330 to contain Famotidine Injectable. One anesthesia cart contained two vials of Famotidine Injectable and the other anesthesia cart contained three vials of Famotidine Injectable stored at room temperature.
B. The manufacturer label of Famotidine Injectable was reviewed on 06/08/11 at 1325. The label reflected Famotidine Injectable must be refrigerated.
C. Certified Registered Nurse Anesthetist #1 verified through interview on 06/08/11 at 1335 the Famotidine Injectable was stored at room temperature on the two anesthesia carts and available for patient use.

Based on observation and review of the "Emergency Room Register" (log), review of Medical Staff Rules and Regulations, policy and procedure and interview, it was determined the facility failed to assure the final disposition of the patient was included on the emergency room log for 181 of 1279 entries from 05/01/11-06/02/11. The failed practice did not allow for tracking care provided to each patient. The failed practice affected the patients identified and had the potential to affect all patients listed on the emergency room log. The findings were:

A. Observation of the "Emergency Room Register on 06/08/11 for the period 05/01/11-06/02/11 revealed 181 entries that did not include the final disposition of the patient.
Review of Emergency Services, section III of the Medical Staff Rules and Regulations, page 10 stated "An appropriate emergency log shall be maintained listing every person who presents himself or is brought to the emergency department for treatment or care and a notation concerning treatment or transfer." Item # I further stated, "and final disposition including instructions given to patients or patient's family relative to necessary follow-up care."
B. The Director of Nursing confirmed the findings in an interview on 06/08/11 at 1115.