HospitalInspections.org

Based on medical record review, document review and interview it was revealed the facility to employ methods for preventing and controlling the transmission of infections within the hospital and between the hospital and other institutions and settings for all visitors presenting to the facility to visit with patients diagnosed with active Novel Coronavirus 2019 (COVID-19) infections. This failure has the potential to negatively impact all patients, visitors, and staff at the facility.

Findings include:

1. A medical record review was conducted for patient #1 on 05/17/21. The patient presented to the Emergency Department (ED) on 02/22/21 via ambulance. The patient was diagnosed with pneumonia related to COVID-19 and admitted to the Intensive Care Unit (ICU). The patient's daughter was noted to be at the patient's bedside on 02/25/21 at 4:00 p.m. by Registered Nurse (RN) #2.

2. The policy titled "COVID Visitor's Policy" effective 12/04/20 until 5/13/20 was reviewed. The policy states in part: "Nursing Units-ED/ICU: No visitors for COVID + patient unless end of life." "...There can be exceptions to these guidelines at any time."

3. A document titled "General Visitation Guidelines" in effect 05/14/21 was reviewed. The document states in part: "COVID-19 Positive Patients Still on Isolation/Patients Suspected of Being COVID-19 Positive: Visitation will be allowed on the fifth (5th) day of the patient's hospital stay. One (1) visitor per patient per day for a maximum of one (1) hour visit duration anytime during the visitation hours of 12N-6PM. No switch out allowed. Visitors must check in at the Nurses Station first prior to entering a patient's room. A member of the nursing staff will provide instructions on PPE (personal protective equipment) and other proper hygiene procedures."

4. An interview was conducted with RN #2 on 05/17/21 at 12:48 p.m. She stated, "The patient's breathing got worse so a discussion was made about the daughter coming to visit. The supervisor approved the visit, and the daughter came in once." She did not remember how long the patient's daughter stayed or what PPE was given to her for her visit.

5. An interview was conducted with the Infection Preventionist on 05/18/21 at 9:00 a.m. Regarding visitation with COVID-19 positive patients she stated, "I would expect them to have full PPE on just like the staff, including a N-95 mask, face shield, gown, gloves and booties. They would have to follow guidelines just as an employee. I would expect the visitation to be limited to one (1) person per day, for a limited time, no more than fifteen (15) minutes to reduce exposure risk." She then stated, "Since the visitor could not be fit tested for the N-95 mask, I guess a surgical mask and face shield would be sufficient. The visitor would have to be instructed how to properly remove the PPE and wash their hands upon leaving the patient's room." She explained she did not know what the nursing process was for giving PPE and educating the visitors of COVID-19 positive patients.

6. On 05/18/21 at 10:00 a.m. the Chief Quality Officer confirmed there was no documentation of what PPE was given to patient #1's visitor, the education provided to her or how long she remained in the room.

7. On 05/18/21 at approximately 2:00 p.m. the Chief Nursing Officer concurred there was no delineation of exactly what PPE would be provided to visitors of COVID-19 patients, or what education was provided in both the previous policy and the current visitation guidelines.