HospitalInspections.org

Based on interview and record review the nursing staff failed to supervise the care of 1of 11 patients reviewed (Patient ID# 1). The nursing staff failed to place a patient in isolation exhibiting potential symptoms of Tuberculosis and failed to initiate a physician order for a cough medication in a timely manner.

Findings include:

ISOLATION PRECAUTIONS

A History and Physical for patient ID# 1 dated 6/22/10 stated "51 year old male was admitted with a chronic persistent cough." A physician order dated 6/22/10 revealed the physician was ruling out Tuberculosis (TB) by ordering a "Sputum for Acid Fast Bicilli." The Physician orders from 6/21/10 to 6/24/10 did not reflect an order for Respiratory Isolation. The patient signed out against medical advice on 6/24/10. The patient presented to another hospital the same day and was diagnosed with Tuberculosis per the discharge summary dated 6/28/10.

A Nursing Admission Assessment dated 6/21/10 included a Tuberculosis screening section. The screen revealed the patient answered "yes" to a cough greater than three weeks, unplanned weight loss, and night sweats. The section stated to "Notify Physician and Infection Control if "yes" was answered to any of the questions. There was no documentation in the record to reflect that the Physician and the Infection Control Practitioner were notified.

A Pulmonary Specialist (ID# 60) that treated patient ID# 1 acknowledged 7/15/10 at 1 p.m. that he should have placed patient ID# 1 on respiratory isolation.

The Infection Control Practitioner (ID# 54) stated she was not notified by the nursing staff of patient
ID# 1's initial TB screen and acknowledged the patient should have been placed in an isolation room.

Record review of a policy titled "Tuberculosis Exposure Control Plan" dated 8/08 stated "All patients suspected of having or known to have infectious pulmonary or laryngeal TB will be placed in an Airborne Isolation room."

PHYSICIAN ORDER

Physician orders dated 6/21/10 at 2:30 p.m. revealed a cough medicine (Tessalon Pearls) was ordered to be given three times a day to patient ID# 1. Nursing staff did not administer the first dose of the cough medication until the next day on 6/22/10 at 10:30 a.m.

The pharmacist (ID# 66) acknowledged 7/15/10 at 3 p.m. that he could not determine why the nursing staff waited until the next day to begin patient ID# 1's cough medication.