HospitalInspections.org

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Based on observation, document review and interview, the staff did not ensure that patient information was secured in four (4) of fifteen (15) observations.

This lapse in the protection of patient privacy placed patients at risk for the unauthorized use and disclosure of protected health information.

Findings:

Observations in the facility's Emergency Department (ED) during a tour between 10:00AM and 3:00PM on 12/10/18 identified the following:

Patient #13's Medical Record information was observed on a Nursing Work Station accessible by patients and visitors, unsecured and unattended.

Patient #16's Medical Record information was observed on a medication cart, outside a patient's room, accessible to patients and visitors, unsecured and unattended.

Similar findings of unsecured patient information were observed for Patients #14 and #15.

These observations were made in the presence of Staff G (Emergency Department/ED Nurse Educator) and Staff H (Nurse Manager Pediatric ED), who confirmed these findings.

The facility Policy and Procedure titled "Confidentiality of Protected Health Information," last reviewed June 2016, contained the following statements: "It is the duty of everyone covered by this policy to maintain the confidentiality of all Protected Health Information (PHI). PHI is defined as any...written...individually identifiable health information...that identifies the individual who is the subject or based on which there is a reasonable basis to believe that the individual who is the subject, can be identified."
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Based on observations, Medical Record review, document review and interviews, the staff did not: (A) document the education of patients or visitors on Isolation Precautions in four (4) of seven (7) Medical Records reviewed, and (B) don the appropriate Personal Protective Equipment (PPE) when caring for patients in Isolation Rooms.

These Infection Control breaches place all patients at risk for exposure to infectious diseases.

Findings pertinent to (A):

Observations in the facility's Pediatric Emergency Room during a tour on 12/10/18 between 12:20PM and 1:30PM identified the following:

Patient #6 on Droplet Precautions, had two (2) family members in the Isolation Room without a surgical mask.

Chart review of Patient #6's Medical Record with Staff H (Nurse Manager) identified that this patient was admitted on 12/10/18 at 10:39AM with cough and fever. No documented evidence of Droplet Isolation Precaution Education to the family / visitors could be found at the time of the review.

Patient #7 on Contact / Droplet Precautions, had one (1) family member in the Isolation Room, without a surgical mask, gown or gloves.

Chart review of Patient #7 with Staff H (Nurse Manager) identified that this patient was admitted on 12/09/18 at 11:23PM with chest congestion and cough. No documented evidence of Contact or Droplet Isolation Precaution Education to the family / visitors could be found at the time of the review.

Similar findings were found for Patients #1 and #2.

Staff D (Director) and Staff H (Nurse Manager) confirmed these findings at the time of observation and Medical Record review.


Findings pertinent to (B) include:

Observations in the facility's Pediatric Emergency Department during a tour on 12/10/18 between 12:20PM and 1:30PM, identified the following:

Staff E (RN/Registered Nurse) was observed in a Contact/Droplet Isolation Room without donned gloves, touching and moving the patient's overbed table.

Staff J (RN) was observed entering a Contact/Droplet Isolation Room without donned gloves. The staff member pulled the patient's privacy curtain, retrieved supplies from a supply cabinet, then touched the vital sign monitor in the room without donned gloves.

Staff H, Staff D and Staff I (Infection Prevention Nurse) confirmed these findings at the time of observation.

The facility's Policy and Procedure titled "Patient on Precautions" last revised May 2012 stated: "The...nurse providing care for the patient shall explain the appropriate precautions to the patient [or parent] and document accordingly...the nurse...will place the patient on appropriate precautions...when a disease or organism is suspected...Visitors shall also be informed of the necessary precautions and encouraged to comply with the Isolation procedures. Education shall be provided as needed and documented within the...medical record..." and "don gloves at the entrance of the door...hands should not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients or environments."
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Based on document review, Medical Record review and interview, the Emergency Department (ED) Staff did not ensure that patients assessed with reported pain levels of seven (7) and above, were assigned an Emergency Severity Index (ESI) Level of two (2), as per facility Policy, in three (3) of three (3) Medical Records reviewed.

Findings included:

The facility Policy and Procedure titled "Triage- Emergency Severity Index (ESI)" last revised on 11/12/2015, directed Nursing Staff to assign an "ESI LEVEL TWO" to patients with a "high risk situation...and/or severe pain (patient rating of greater than or equal to 7 on 0-10 pain scale)."

Review of Patient #3's Medical Record identified that this patient presented to the ED on 10/09/18 at 10:07PM and was triaged at 10:09PM. Pain levels of eight (8) both at rest and with activity were documented. Patient #3 was assigned an ESI level of three (3). The patient was not evaluated by a provider and left the facility without being seen on 10/10/18 at 1:40AM.

Review of Patient #11's Medical Record identified that this patient presented to the ED on 10/09/18 at 5:49PM and was triaged at 5:57PM. The patient had pain levels of eight (8) both at rest and with activity. Patient #11 was assigned an ESI Level of three (3). The patient was not evaluated by a provider and left the facility without being seen on 10/09/18 at 9:44PM.

Review of Patient #17's Medical Record identified that this patient presented to the ED on 01/05/18 at 11:30PM and was triaged at 11:35PM. The patient had a pain level of seven (7) at rest, and a pain level of eight (8) with activity and was assigned an ESI Level of four (4). The patient was not evaluated by a provider and left the facility without being seen on 01/06/18 at 2:13AM.

An interview with Staff A (Executive Director of Patient Care Services) on 12/13/18 confirmed the above findings.