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Based on interview and record review the facility failed to show documentation of repositioning of a patient with pressure injury (PI, localized damage to the skin as well as underlying soft tissue, usually occurring over a bony area of the body or related to medical device contact) for one of 30 sampled patients (Patient 5). This deficient practice had the potential to exacerbate skin break down.

Findings:

During a record review of Patient 5 ' s "Admission Assessment Inquiry," dated 9/20/2023, Patient 5 ' s Braden Scale Score (assessment tool used to determine the patient's risk for further skin breakdown) was 14/23 on 9/19/2023; this score noted that there was a potential for skin breakdown due to friction and shear (the forces exerted between two surfaces and the force weighing down on a surface, respectively).

During a record review of Patient 5 ' s "Daily Assessment of Activities of Daily Living" ranging from 9/19/2023 at 8:00 P.M. and 9/20/2023 at 8:00 A.M., there was documentation of plan to reposition patient every 2 hours. However, there was only documentation of Patient 5 being repositioned to the left side on 9/19/2023 at 8:00 P.M. This record review was confirmed with the Medical Surgical Charge Nurse.

During a record review of Patient 5 ' s "Patient Care Plan (CP-provides a centralized document of the patient ' s condition, diagnosis, the healthcare team ' s goals for the patient, and a measure of the patient ' s progress)" for (Patient 5)', there were care plans for the following: Alteration in Comfort, Pain, Infection, Fall Risk/Potential for Falls (unplanned descent to the floor with or without injury to patient). However, there was no Care Plan regarding pressure injury prevention.

During a record review of the policy titled "Wound Assessment and Management," approved 7/2022, the policy indicated that "all inpatient staff must initiate a care plan for pressure injury, non-pressure related wounds, and/or Braden Score based care plans." This document also specified that "patients at risk for pressure injury should be repositioned using simple and safe techniques; need to make small position changes every 30 to 60 minutes/ need to be inspected for reddened areas, broken skin, bruised areas, blisters, moisture changes and swelling."

During an interview on 9/20/2023 at 2:30 P.M., the Medical/Surgical (Med/Surg, a specific area of a hospital that focuses on the care of adult patients from a variety of medical conditions that are not critical) Charge Nurse stated that when the patient's Braden Scale Score (quantifies pressure injury risk through an assessment sequence and calculating a numerical score to assign risk) is below 17, nursing should implement repositioning of the patient every 2 hours. The Med/Surg Charge nurse also said that the nurse caring for Patient 5 should have documented repositioning of the patient since the first skin assessment.

Based on observation, interview, and record review the facility failed to:

1. Follow infection control protocol while a maintenance worker was replacing window glazing (film to reduce glare from the sun into the room) in a room that was designated for patients requiring contact isolation (precautions that must be taken for patients who have germs that can spread by touching the patient or surfaces in their room). This deficient practice increased the chances of spread of infection between the maintenance worker and the patient who was still in the room.

2. Ensure Patient 22, who tested positive for Coronavirus ([COVID-19], an illness caused by a virus spread from person to person) was discharged to a setting where isolation (additional precautions taken to prevent transmission of infectious agents, such as bacteria or viruses, between people) could be continued so as not to spread infection to other people. This deficient practice had the potential to spread infection to other patients and staff.

3. Ensure staff practiced appropriate infection control practices for one of one sampled patient (Patient 23) when Registered Nurses (RNs) failed to recognize Patients 23 ' s peripherally inserted central catheter (PICC-a long, flexible catheter [thin tube] that is put into a patient ' s vein to administer intravenous [through the vein] medications) line dressing was not properly placed and did not change the transparent dressing per facility ' s PICC line Maintenance Policy. This deficient practice had a potential risk for infection.

Findings:

During an observation on 9/19/2023 at 2:10 P.M. with Medical/Surgical (Med/Surg, a specific area of a hospital that focuses on the care of adult patients from a variety of medical conditions that are not critical) Charge Nurse, a maintenance worker was in room 21 occupied by one patient.

The maintenance worker was on a step ladder at the far end of the room applying window glazing. The maintenance worker had donned (placed on) a surgical mask only. At that time, signage for "Contact Precautions" was observed on the wall next to the door to room 21. The sign read: "Clean hands when enter/leave, gown and gloves at door; use patient dedicated equipment; clean and disinfect shared equipment."

During an interview on 9/19/2023 at 2:10 P.M., the maintenance worker stated that he did not check in with nursing staff and was not aware of the precaution that should be taken before entering the room.

During an interview on 9/19/2023 at 2:12 P.M., the Med/Surg Charge Nurse stated that all persons who enter a patient ' s room should check with nursing staff and don the appropriate PPE (personal protective equipment such as gloves, gown, mask) before entering a room designated as requiring isolation precautions.

2. During a review of the "Emergency Department Note" (indicating patient date of admission 7/17/2023 at 9:06 A.M.), this document indicated that Patient 22 was brought into the facility with flu-like symptoms including sore throat and body aches. The Emergency Department Note indicated that Patient 22 tested positive for Coronavirus ([COVID-19], an illness caused by a virus spread from person to person) on 7/17/2023 and Patient 22 stated the flu-like symptoms started 2 days prior to hospital visit on 7/17/2023. The Emergency Department Note further indicated that Patient 22 was a candidate for taking medication for his (Patient 22) flu-like symptoms; Patient 22 was given a prescription for his medication and the attending physician stated Patient 22 was stable enough to be discharged. The 'Plan' in the Emergency Department Note indicated medication for symptoms and isolation until COVID-19 testing was shown to be negative.

During a review of the "Home Isolation Instructions for People with Covid-19 Infection - Discharge Care," this form indicated that Patient 22 was to be discharged from the facility on 7/17/2023; follow up with primary care provider as needed in the next 2 - 3 days; increase fluids; isolation as indicated until tested negative, use medication as indicated.

During a review of the "Homeless Discharge Planning Policy", reviewed 9/2022), the policy indicated that in order to identify homeless patients: registration staff, nursing staff, or other members of the health care team will seek to identify homeless patients as soon as possible upon arrival to the emergency department by asking patients if they are homeless. Document of the patient ' s living status will be entered into the patient record. This policy stated that a patient may be considered homeless if that person has a primary night-time residence that is supervised publicly or privately operated shelter designed to provide temporary living accommodations. The 'Discharge Planning' part of this document specified that homeless patients will be offered assistive needs such as assisted living, recuperative care, and board and care; barriers to appropriate discharge will be identified and addressed.

During an interview on 9/21/2023 at 11:30 A.M., the Case Management Director stated that patients who are suspected of being positive for COVID-19 should be referred to Social Services; the Case Management Director stated that it is the responsibility of physicians and nurses in the emergency department to relay patients' home status to social services. The Case Management Director stated Patient 22 should not have been returned to the shelter from which he (Patient 22) came and that staff in the emergency department did not notify social services of this patient's home status.

During an interview on 9/21/2023 at 11:40 A.M., the ED Director stated that when patients are identified as homeless, nurses or physicians have a duty to refer those patients to social services. The ED Director subsequently said that Patient 22 should not have been discharged to the shelter from which he came due to his need to isolate himself from others who could be affected by Patient 22 ' s COVID-19.

3. During a review of Patient 23 ' s "Face Sheet," the Face Sheet indicated Patient 23 was admitted on 9/12/2023 for right foot Osteomyelitis (infection in a bone).

During a review of Patient 23 ' s "Physician Progress Note (PPN)," dated September 2023, the "PPN" indicated, Patient 23 will have a peripherally inserted central catheter (PICC-a long, flexible catheter [thin tube] that is put into a patient ' s vein to administer intravenous [through the vein] medications) line with 6 weeks of antibiotics.

During a review of Patient 23 ' s "Care Plan (CP-provides a centralized document of the patient ' s condition, diagnosis, the healthcare team ' s goals for the patient, and a measure of the patient ' s progress)," dated September 2023, the "CP" indicated to change central line dressings per protocol.

During a review of the facility ' s policy and procedure (P&P) titled, "Vascular Access Insertion, Maintenance, and Removal Policy," the P&P indicated "PICC is a type of Central line and a transparent dressing is changed every seven days or when the dressing integrity is compromised."

During a concurrent observation and interview on 9/19/2023 at 2:38 P.M., with Licensed Vocational Nurse (LVN 3) 3 in the room of Patient 23, Patient 23 was observed lying in bed. Patient 23 had a PICC line on his right upper arm. Patient 23 ' s PICC line dressing was not properly placed due to the transparent cover not fully covering the PICC Line. LVN 3 stated "PICC line looks exposed, not covered properly by the dressing, and needs to be changed. It is a risk for infection to happen. I will let the Charge Nurse know to change the dressing."

During an interview on 9/20/2023 at 12:05 P.M., with Infection Control Preventionist (ICP) 1, ICP 1 stated Patient 23 ' s PICC line dressing was not properly placed and a potential risk for infection. ICP stated, "Staff will be educated on how to do PICC line dressing changes."

During an interview on 9/21/2023 at 9:57 A.M.. with Nursing Director (ND) 1, ND 1 stated "Patient 23 ' s PICC line dressing was not done correctly. The PICC line dressing was changed immediately after it was brought to our attention. It is a risk for infection and told the nurses to make it right and change the dressing." ND 1 stated "We educated all the staff on central line assessment and proper placement of dressing for PICC line to prevent this from happening again."