HospitalInspections.org

Based on review of facility policies, medical record review, observations and patient and staff interviews, the facility staff failed to ensure the initiation of isolation precautions was documented in the patient's medical record in a timely manner for 4 of 6 patients (Patients' #1, #2, #5 and #7) placed on Isolation Precautions due to meeting MRSA screening criteria.

The findings included:

Review on 07/11/2017 of the facility policy "Multidrug Resistant Organisms (MRSA [Methicillin-resistant Staphylococcus aureus]..." (Policy #1848056, revised 10, 2015), revealed "... Patients admitted to [Named Facility and name of local facility] who met the following criteria will be screened for MRSA and placed on contact precautions: A. Confirmed previous history of MRSA.. B. Residents of skilled and long term care facilities..."

1. Review on 07/11/2017 of Patient #1's medical record, revealed the patient was admitted on 04/15/2017 at 2330 with pneumonia. The patient was screened for MRSA on 04/15/2017 at 2313 because he came from a Skilled Nursing Facility (SNF). Review revealed the first documentation regarding isolation precautions was "Isolation continued" on 04/16/2017 at 1000 (10 hours and 43 minutes after the screening was performed).

Interview on 07/13/2017 at 1120 with the Director of Quality and the Quality Manager, revealed they would have expected the initiation of isolation to be documented immediately upon the MRSA screen. Our observations and daily rounds by the [Infection Preventionist] have not previously shown an issue with the actual initiation of isolation, so we feel this is a documentation error and an opportunity for system improvements and nursing education." The interview revealed there was no specific policy indicating when documentation of the initiation of isolation begins.

2. Review on 07/11/2017 of Patient #2's medical record revealed the patient was admitted on 06/09/2017 at 1911 with a UTI (urinary tract infection) and sepsis (infection in the blood). The patient was screened for MRSA on 06/09/2017 at 2300 as he was a resident in a SNF. Review revealed the first documentation regarding isolation precautions was "Isolation Precautions" on 06/10/2017 at 0105 (2 hours and 5 minutes after the screening was performed).

Interview on 07/13/2017 at 1120 with the Director of Quality and the Quality Manager, revealed they would have expected the initiation of isolation to be documented immediately upon the MRSA screen. Our observations and daily rounds by the [Infection Preventionist] have not previously shown an issue with the actual initiation of isolation, so we feel this is a documentation error and an opportunity for system improvements and nursing education." The interview revealed there was no specific policy indicating when documentation of the initiation of isolation begins.

3. Review on 07/11/2017 of Patient #5's medical record revealed the patient was admitted on 05/22/2017 at 1829 with a humeral fracture broken upper leg bone). The patient was from a SNF, and was screened for MRSA on 05/22/2017 at 2230. Review revealed the first documentation regarding isolation precautions was "Isolation Continues" on 05/23/2017 at 1541 (12 hours and 11 minutes after the screening was performed).

Interview on 07/13/2017 at 1120 with the Director of Quality and the Quality Manager, revealed they would have expected the initiation of isolation to be documented immediately upon the MRSA screen. Our observations and daily rounds by the [Infection Preventionist] have not previously shown an issue with the actual initiation of isolation, so we feel this is a documentation error and an opportunity for system improvements and nursing education." The interview revealed there was no specific policy indicating when documentation of the initiation of isolation begins.

4. Review on 07/11/2017 of Patient #7's medical record revealed the patient was admitted on 07/09//2017 at 1022 with Type II Diabetes. The patient had a history of MRSA, and was screened for MRSA upon admission to the ICU (Intensive Care Unit) on 07/09/2017 at 1612. Review revealed the first documentation regarding isolation precautions was "Isolation Continued" on 07/10/2017 at 0800 (15 hours and 49 minutes after the screening was performed).

Interview with Patient #7 on 07/11/2017 at 1220, revealed he had been in the ICU and was transferred to the Medical Surgical Unit today. The patient stated when he first came in he was sort of "out of it," but the staff had been using their yellow gowns and gloves since his admission.

Interview on 07/13/2017 at 1120 with the Director of Quality and the Quality Manager, revealed they would have expected the initiation of isolation to be documented immediately upon the MRSA screen. "Our observations and daily rounds by the [Infection Preventionist] have not previously shown an issue with the actual initiation of isolation, so we feel this is a documentation error and an opportunity for system improvements and nursing education." The interview revealed there was no specific policy indicating when documentation of the initiation of isolation begins.

Observation on 07/11/2017 between 1100 and 1250 and on 11/12/2017 from 1120 to 1140 on the orthopedic and medical surgical floors revealed isolation caddies hanging over the doors of all patient's with isolation precautions.

Interview on 07/11/2017 at 1150 with Patient # 6, revealed she was on reverse isolation (isolation to prevent infection in a patient with a weak immune system). The interview revealed staff were taking precautions and wearing their PPE (personal protective equipment), including a mask, every time they entered her room.

Interview on 07/11/2017 at 1400 with Patient #10, revealed he did not meet the MRSA screening criteria when he was admitted yesterday (7/10/2017), but the doctor decided to order a MRSA test today (07/11/2017). The patient stated the staff had been wearing the yellow gowns and gloves since they swabbed him for MRSA this morning.

NC00129005