Parkland Health Center - Bonne Terre

“COMPLIANCE WITH 489.24 CFR(s): [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 48359 Based on interview, record review and policy review, the hospital failed to provide, within its capability and capacity, an ongoing assessment and reassessment during a medical screening exam (MSE) sufficient to determine the presence of an Emergency Medical Condition (EMC) for two patients (#1and #25) of 31 Emergency Department (ED) records reviewed from 09/15/24 to 03/24/25. This failed practice had the potential to cause harm to all patients who presented to the ED. Findings included: Review of the hospital’s policy, “Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an EMC),” dated 10/01/24, showed when an individual comes to the ED and requests emergency care or treatment the hospital must provide an appropriate MSE, beyond medical triage (process of determining the priority of a patient’s treatment based on the severity of their condition), by qualified medical personnel. A MSE is an examination sufficient to reasonably indicate the presence or absence of an “EMC” for an individual. Review of the hospital’s document, “Medical Staff Bylaws and Rules and Regulations,” dated 01/01/2024, showed a MSE will be provided to all patients presenting for emergency services. Review of the hospital’s undated policy, “Suicide Prevention,” showed: - Patients who have had suicidal ideations (SI, thoughts of causing one’s own death) or with suicidal behaviors (any action that could cause one’s own death) need additional individualized precautions implemented to keep them safe from their own actions. - Intervention will be applied based on the stratified risk level. - Patients at a high-risk for suicide based on the screening will be assessed further by a Qualified Mental Health Provider (QMHP). - Precautions for high-risk patients may not be removed or reduced until the QMHP has assessed the patient and the appropriate provider has determined the most appropriate level of care. - High-risk suicide precautions (SP, precautions taken to ensure patients are safe and free of self-injury or self-harm) include immediate implementation of continuous one-to-one (1:1, continuous visual contact with close physical proximity) observation. - Patients must have an assigned staff observer directly observing them 1:1 continuously. - The staff observer must be close enough to the patient to immediately intervene in any self-harm act and must remain with the patient continuously until precautions are discontinued by a provider. - Patients at high-risk for suicide will also be placed on elopement precautions (EP, interventions to prevent someone from leaving who may be at risk for self-harm or injury). Review of the hospital’s undated policy “Elopement (when a patient makes an intentional, unauthorized departure from a medical facility) Risk Assessment, Intervention and Response,” showed: - Patients determined to be at risk for elopement should not be permitted to leave. - Patients who are observed to have SI are at risk for elopement. - If a patient is a high-risk for suicide, they are automatically on EP. - ED patients identified as an elopement risk at triage should be placed in a room as soon as possible, away from the exit doors. If waiting for a room, the patient is to be placed in a treatment area with 1:1 observation. - Notify Public Safety and the Charge Nurse.”

“MEDICAL SCREENING EXAM CFR(s): (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 48359 Based on interview, record review and policy review, the hospital failed to provide, within its capability and capacity, an ongoing assessment and reassessment during a medical screening exam (MSE) sufficient to determine the presence of an Emergency Medical Condition (EMC) for two patients (#1 and #25) of 31 Emergency Department (ED) records reviewed from 09/15/24 to 03/24/25. This failed practice had the potential to cause harm to all patients who presented to the ED. Findings included: Review of the hospital’s policy, “Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an EMC),” dated 10/01/24, showed when an individual comes to the ED and requests emergency care or treatment the hospital must provide an appropriate MSE, beyond medical triage (process of determining the priority of a patient’s treatment based on the severity of their condition), by qualified medical personnel. A MSE is an examination sufficient to reasonably indicate the presence or absence of an “EMC” for an individual. Review of the hospital’s document, “Medical Staff Bylaws and Rules and Regulations,” dated 01/01/2024, showed a MSE will be provided to all patients presenting for emergency services. Review of the hospital’s undated policy, “Suicide Prevention,” showed: - Patients who have had suicidal ideations (SI, thoughts of causing one’s own death) or with suicidal behaviors (any action that could cause one’s own death) need additional individualized precautions implemented to keep them safe from their own actions. - Intervention will be applied based on the stratified risk level. - Patients at a high-risk for suicide based on the screening will be assessed further by a Qualified Mental Health Provider (QMHP). - Precautions for high-risk patients may not be removed or reduced until the QMHP has assessed the patient and the appropriate provider has determined the most appropriate level of care. - High-risk suicide precautions (SP, precautions taken to ensure patients are safe and free of self-injury or self-harm) include immediate implementation of continuous one-to-one (1:1, continuous visual contact with close physical proximity) observation. - Patients must have an assigned staff observer directly observing them 1:1 continuously. - The staff observer must be close enough to the patient to immediately intervene in any self-harm act and must remain with the patient continuously until precautions are discontinued by a provider. - Patients at high-risk for suicide will also be placed on elopement precautions (EP, interventions to prevent someone from leaving who may be at risk for self-harm or injury). Review of the hospital’s undated policy “Elopement (when a patient makes an intentional, unauthorized departure from a medical facility) Risk Assessment, Intervention and Response,” showed: - Patients determined to be at risk for elopement should not be permitted to leave. - Patients who are observed to have SI are at risk for elopement. - If a patient is a high-risk for suicide, they are automatically on EP. - ED patients identified as an elopement risk at triage should be placed in a room as soon as possible, away from the exit doors. If waiting for a room, the patient is to be placed in a treatment area with 1:1 observation. - Notify Public Safety and the Charge Nurse. Record review of Patient #1’s medical record, dated 11/06/24, showed: - At 7:04 PM, a 27-year-old male presented to the ED requesting mental health medication. He stated that he had suicidal thoughts and dreams. - His past medical history included bipolar disorder (a mental disorder that causes unusual shifts in mood by alternating periods of emotional highs and lows), depression (extreme sadness that does not go away), drug abuse, Post-Traumatic Stress Disorder (PTSD, a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock) and schizophrenia (serious mental disorder that affects a person’s ability to think, feel, and behave clearly). - At 7:36 PM, his Columbia Suicide Severity Rating Scale (C-SSRS, scale to evaluate a person’s risk to self-inflicted harm and desire to end one’s life) showed he was a high suicide risk. - At 7:42 PM, orders were written for SP and EP. - At 8:11 PM, he needed a mental health assessment. His significant other (SO) encouraged him to stay for treatment. He did not indicate he would attempt to elope and verbalized an agreement with the plan of care. The nurse left him in the company of his SO while she consulted with other staff members to develop a plan for a room placement. The ED room designated for mental health patients was occupied and the only place available was in the hallway. When the nurse returned to the triage room both the patient and his SO were gone. Security was contacted and video reviews were completed. The patient walked out of the hospital with the SO. The House Supervisor, Risk Management and the local police department were notified. - At 8:37 PM, the disposition was set to eloped. During a telephone interview on 03/26/25 at 1:34 PM, Staff I, Physician Assistant (PA, a type of mid-level health care that can serve as a principal healthcare provider), stated that he did not have contact with the patient. The patient eloped from triage and providers do not assess patients in the triage area. When there were no beds available, he expected every patient assessed to be high-risk for suicide to be placed in the hallway, with a 1:1 observer in place at all times. The goal was to keep the patients safe. During a telephone interview on 03/26/25 at 4:01 PM, Staff J, Registered Nurse (RN), stated that she asked the C-SSRS questions specifically as they were written. The patient was able to answer the questions, and his answers seemed to be truthful. That night the hospital was “very busy,” all of the beds were full, and patients were waiting in the hallway. She stepped out of the triage area to find a place for the patient and when she returned, he was gone. His SO encouraged him to seek treatment. She felt safe leaving the patient with the SO for a few minutes while she sought a bed. When she discovered he had eloped she notified the House Supervisor. She reviewed the video footage to identify which direction he traveled towards, contacted the local police department, informed them which direction he traveled and provided his home address. He did not return to the ED. She recognized all high-risk suicide patients required 1:1 observation, someone must always stay with the patient. She “would never do this again.” In the future, she would call for a security officer to ensure the patient was safe if a 1:1 observer was not immediately available. The hospital had to look out for the safety of patients who expressed suicidal thoughts. During an interview on 03/25/25 at 9:05 AM, Staff A, Clinical Excellence Director, stated that the triage door did not lock, and patients could leave the triage area without being seen. Review of Patient #25’s medical record, dated 03/07/25, showed: - At 9:02 PM, a 38-year-old female arrived at the ED, stated she was on blood thinners, had bloody urine that day and blood in her stool for the last few days. - She had a history of kidney stones, pulmonary embolus (PE, blood clot in the lung) and rectal hemorrhage (excessive bleeding). - Orders included urinalysis (a laboratory examination of a person’s urine) and blood tests. - No stool tests were ordered. - Urine and blood laboratory results confirmed bloody urine with a normal hemoglobin (Hgb, a protein in red blood cells that carries oxygen throughout the body) level. - The medical decision-making indicated kidney stones possibly contributed; she was not in pain. - She was advised to follow up with her physician and a urologist (a physician who specializes in diseases of the urinary system). During a telephone interview on 03/26/25 at 1:20 PM, Staff E, ED Medical Director, stated that a patient at high-risk for suicide required 1:1 observation and was not allowed to elope from the hospital. He expected all high-risk suicide interventions to be maintained until a provider changed the intervention orders. Hospital staff should follow the policies and procedures for suicide and elopement prevention. He stated that stable patients with bloody urine who had no pain would not necessarily require a computed tomography (CT, a combination of x-rays [test that creates pictures of the structures inside the body-particularly bones] and a computer to produce detailed images of blood vessels, bones, organs and tissues in the body) scan. Laboratory results and the patient’s presentation were helpful to determine if the patient had a bleeding emergency. The ED did not have stool sample tests for active bleeding. Rectal exams could be considered. During a telephone interview on 03/26/25 at 1:38 PM, Staff F, Physician, stated that laboratory values and physical examinations helped to determine if a CT scan was necessary. ED staff ruled out emergencies. During an interview on 03/26/25 at 12:28 PM, Staff H, ED Manager, stated that patients assessed to be at a high suicide risk required 1:1 observation and were not to be left alone. The hospital did not use SOs as a patient observer. She stated that diagnoses were not always achievable in the ED. Stable patients with non-obstructive kidney stones and no pain were discharged to follow up with their provider. If the patient’s condition was not life-threatening, then they were stable. During a telephone interview on 03/26/25 at 10:03 AM, Staff G, RN, stated that some patients with bloody urine did not require CT scans. CT scans were considered if patients were in pain or had a bad infection. Patients with blood in their stool were not tested with stool sample cards. Sometimes doctors did rectal exams. She expected blood tests to be ordered that indicated active bleeding and a consultation to a gastroenterologist (physician who specializes in the digestive system). Some doctors ordered CT scans if indicated. During a telephone interview on 03/26/25 at 4:45 PM, Staff K, RN, stated that they did not use stool sample cards to detect blood in stool. Stool samples sent to the laboratory had delayed results. Doctors could order CT scans for patients with histories of kidney stones or gastrointestinal (GI) bleeds. Physicians weighed the risks versus the benefits of imaging radiation (the use of energy waves to diagnose or treat disease). Patients were not exposed to radiation if the test was not necessary to determine the presence of an emergency. Emergent patients showed symptoms such as significant blood loss, paleness, sweaty skin and dizziness. If a patient’s condition was not life threatening, a CT scan was not always performed in the ED.”

“Infect prevent & control program org & policy CFR(s): (a)(2) The infection prevention and control program, as documented in its policies and procedures, employs methods for preventing and controlling the transmission of infections within the REH and between the REH and other health care settings; This Standard is not met as evidenced by: 39840 Based on observation, interview and policy review, the hospital failed to: - Remove expired patient care supplies; - Clean the surface and base of the sexual assault nurse examiner (SANE, a registered nurse or nurse practitioner who has completed specialized training to assist sexual assault victims and collect all forensic evidence and perform exams) supply cart and shelving bins located in the clean utility room; - Remove outdated supplies from the emergency Obstetrics (OB, the branch of medical science concerned with childbirth and caring for and treating women in or in connection with childbirth) cart; - Clean the dry food bins; and - Laminate paper hung on the walls to create a cleanable surface. Findings included: 1. Review of the hospital’s undated policy titled, “Distribution Inventory Process for Supply Chain Managed Inventory Locations: Systems,” showed Supply Chain Staff managed inventories. The Supply Distribution Department maintains the expiration date monitoring and stock rotation. Observation on 09/10/24 at 10:05 AM, in the Emergency Department (ED) medication room two, showed one box of surgical masks with an expiration date of 01/01/24. Observation on 09/10/24 at 9:55 AM, in medication room one, showed one port-a-cath (a small medical appliance installed beneath the skin in the chest region and connects the port to a vein and is used to administer medications and draw blood) access needle expired on 06/30/24 and 22 opened oral syringes. Observation on 09/10/24 at 9:15 AM, in the clean utility room, showed 57 opened gastrostomy tube (G-tube, soft, flexible tube inserted through the skin of the abdomen and into the stomach) syringes with no expiration date. During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the supplies were expired and did not belong in the ED. During an interview on 09/11/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that she expected nursing to observe for expired supplies every month. She agreed expired supplies were found in the ED. 2. Review of the hospital’s undated policy titled, “Distribution Inventory Process for Supply Chain Managed Inventory Locations: Systems,” showed the Supply Distribution Department maintains the physical aspects of supply locations, bins, and shelving. Review of the hospital’s undated document titled, “Bonne Terre Dayshift Schedule,” showed the clean utility room was scheduled for daily cleaning. Observation on 09/10/24 at 9:18 AM, in the clean utility room, showed the SANE cart with dust accumulation on the top and base of the wheels. The wheels had an accumulation of hair and debris. Observation on 09/10/24 at 9:15 AM, in the clean utility room, showed dust accumulation in the storage bins. During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she expected cleanliness in the unit. The Materials Management department staff were responsible for cleaning the bins in the clean utility room. ED staff were responsible for cleaning the equipment. 3. Review of the hospital’s undated document titled, “Instruments Event Related Shelf Life,” showed an event which may render a sterile (completely clean and free from germs) item suspect of being compromised could be a broken seal. Contamination could occur with dust covered supplies. Although requested, the hospital did not provide a policy for maintaining the supplies on the emergency OB cart. Observation on 09/10/24 at 9:25 AM, showed an emergency OB cart with the following unusable items: - One Stat (immediately) Cesarean section (C-section, surgical delivery of a baby through an incision made in the mother’s abdomen and uterus) package with a hole in the outside cover; - Three surgical clamps in the manufacturer’s packaging that had not been sterilized; - One sterilized forcep (surgical instrument used for delivery of an infant) with a degraded and flaked plastic overwrap; - Five opened sanitary napkins; - Seven packages of sutures (a strand or thread used to sew skin and other body tissues together to close up a surgical incision or a tear) with torn edges; - One torn bag of supplies with sterile gowns, drapes and unwrapped masks; - One weighted speculum (an instrument used to open the vagina for visual inspection) in the manufacturer’s packaging that had not been sterilized; - One sterile syringe package where the rubber portion of the syringe was hard and discolored; - Five sterile drape sheets with torn edges; and - Four inhouse sterilized metal basins with loose wrapping and brittle sterilization tape. During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the OB items were not useable and did not belong in the ED. 4. Although requested, the hospital did not provide a policy for the cleaning of dry food bins. Observation on 09/10/24 at 9:00 AM, showed spilled sugar in a dry food bin in the patient’s nutrition area. During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that there was no “narrowed down process” for who was responsible for cleaning the dry food bins. During an interview on 09/11/24 at 12:13 PM, Staff G, CNO, stated that she expected the Dietary staff to keep the dry food bins clean. Spilled products in the dry food bins did not meet her expectations. 5. Review of the undated Center for Disease Control and Prevention Best Practices for Environmental Cleaning in Healthcare Facilities Version Two, showed wall surfaces should be washable. Observation on 09/10/24 at 9:55 AM, showed paper hanging on the walls at the nurse’s station and both medication rooms. During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she preferred “things” were not hung on the wall and all paper hung in the unit was laminated. During an interview on 09/11/24 at 12:13 PM, Staff G, CNO, stated that paper hung on the walls in patient care areas should be laminated to provide a cleanable surface. She agreed non-laminated paper hung on the walls posed an infection prevention concern. 48359”

“Buildings. CFR(s): (a)The condition of the physical plant and the overall REH environment must be developed and maintained in such a manner that the safety and well-being of patients are ensured. This Standard is not met as evidenced by: 48359 Based on observation, interview and policy review, the hospital failed to ensure the safety of suicidal (SI, thoughts of causing one’s own death) patients in the psychiatric (relating to mental illness) preferred room when they failed to: - Remove non-psychiatric safe screws; - Provide shatter proof light covers; and - Remove ligature risks. Findings included: Review of the hospital’s undated policy titled, “Suicide Prevention,” showed: - Patients have the right to be safe in the hospital. Patients who have SI or suicidal behaviors need additional individualized precautions implemented to keep them safe from their own actions. - Staff caring for patients with an assessed suicide risk level of moderate-high or higher will immediately complete an environment sweep of potentially dangerous items. - Ligatures are points within the patient’s environment that could be used for binding, looping or tying something else to in order to create a sustainable point of attachment that may result in self-harm or loss of life such as a hospital bed side rails and certain door handles. - Dangerous items include any other items deemed to be dangerous in the proximity of a patient. Review of the hospital’s document titled, “Environmental Assessment Tool,” dated 03/20/24, showed the tool was used for patients at risk of harm/injury to self and/or violence to others and directed staff to immediately remove all potential hazards. Observation on 09/10/24 at 10:25 AM, in the psychiatric preferred room in the Emergency Department (ED), showed a phone jack cover and door window lock panel with non-psychiatric safe screws. Observation on 09/11/24 at 8:45 AM, in the psychiatric preferred room, showed two commercial door handles with a rigid level design that were patient accessible and posed a ligature risk. A hospital bed with multiple possible ligature risks on the bed frame, including the side rails. Two ceiling lights with fluorescent light tubes, the light covers consisted of a brittle type of plastic that allowed patients access to the glass from the fluorescent light tubes. During an interview on 09/12/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that the presence of non-psychiatric safe screws, non-shatter proof light covers, and a non-psychiatric safe door handle did not meet her expectations of a psychiatric preferred room. She stated she recognized the hospital bed, stretcher and door handle as a ligature risk. During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she “assumed” staff removed the hospital bed and placed a stretcher in the psychiatric preferred room for suicidal patients. During an interview on 09/11/24 at 11:25 AM, Staff A, Registered Nurse (RN), stated that the hospital bed typically stayed in the psychiatric preferred room with the suicidal patient. An ED stretcher could be used, the stretcher did have two side rails. The bed or stretcher may be removed, and the mattress laid on the floor at the nurse’s discretion for the patient’s risk of self-harm.”

“Facilties. CFR(s): (b)(2) Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality. This Standard is not met as evidenced by: 48359 Based on observation, interview and policy review, the hospital failed to complete the inventory checklist on the adult and pediatric (pertaining to children) crash carts (mobile cart which contains emergency medical supplies and medication) and the procedure cart in the Emergency Department (ED). Findings included: Review of the hospital’s undated policy titled, “Crash Cart,” showed the nursing staff, in patient care areas, assumes responsibility for maintaining daily check lists, equipment on cart and patency of locks. Crash carts are checked daily by using crash cart log/daily checklist to verify the oxygen tank is present on the crash cart with greater than 1,000 pounds per square inch (psi); number seal/lock is intact; lock number on the cart matches the last number entered on the crash cart checklist; if separate airway box/bag is used, numbered seal/red lock is intact; defibrillator is functioning properly, plugged in, battery charge indicator light is on and hands free defibrillator pads are present; electrocardiogram (ECG, test that records the electrical signal from the heart to check for different heart conditions) paper is present; packs of electrodes are on the crash cart; appropriate size AMBU bag (a hand held device used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately) and face mask are present; suction machine, if present, is plugged in and functional; crash cart label/check list is complete; stock items expiring within three months are replaced and date/initial checklist when check is complete/accurate. Review of the hospital’s undated document titled, “Parkland Health Center Adult Code Cart Inventory List,” showed on 01/01/24 through 09/10/24, the adult crash cart was checked 05/01/24, 05/09/24, 05/22/24, 05/30/24, 06/02/24, 07/01/24 and 09/09/24. Review of the hospital’s undated document titled, “Parkland Health Center Pediatric Crash Cart Inventory,” showed on 01/01/24 through 09/10/24, the Pediatric crash cart was checked 01/16/24, 02/18/24, 03/21/24, 04/21/24, 07/07/24 and 08/09/24. Review of the hospital’s document titled, “ED Bonne Terre Procedure Cart Inventory,” showed on 01/01/24 through 09/10/24, the cart was checked 05/2024, 06/2024 and 09/2024. During an interview on 09/12/24 at 12:13 PM, Staff G, Chief Nursing Officer (CNO), stated that she expected the crash carts and procedure carts inventory to be completed monthly and each time a cart was used. The missing inventory checks did not meet her expectations. During an interview on 09/11/24 at 11:10 AM, Staff J, ED Manager, stated that she expected the crash carts and procedure carts inventory to be up to date and completed on a monthly basis. During an interview on 09/10/24 at 9:44 AM, Staff D, ED Assistant Nurse Manager, stated that she agreed the crash carts and procedure carts inventory lists were incomplete and had missing dates.”