Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 531311 (X3) Date Survey Completed 11/17/2011
Name of Provider or Supplier Crook County Hospital Street Address, City, State 713 Oak Street, Sundance, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
C0224 MAINTENANCE
CFR(s): 485.623(b)(3)

[The CAH has housekeeping and preventive maintenance programs to ensure that--] drugs and biologicals are appropriately stored;


This STANDARD is not met as evidenced by:
Based on observation, staff interview, and review of policies and procedures, the facility failed to ensure all medications were appropriately secured in 1 of 1 emergency departments. The findings were: Observation of the emergency department on 11/14/11 at 3:12 PM revealed medications were stored in unsecured locations as follows: a. Eleven 10 ml syringes containing normal saline (NS) were located in the intravenous tray sitting on a counter; b. Ten 10 ml syringes containing NS were in an open drawer; c. Three thoracentesis kits containing Lidocaine were stocked on an open shelf; d. A bottle of Tetracaine was in the open tote container used to hold equipment for eye injuries. During the observation, RN #10 acknowledged that all the medications should have been secured as staff were not in the emergency department at all times. According to the facility's policy and procedure, "Drug Storage," revised 6/1/08, "Non schedule drugs will be stored inside locked cabinets that are designated as drug storage only...Non scheduled drugs which are stocked in the ER will be stored in a locked cabinet..."