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Based on medical record review, staff interview, and facility policy review, the facility failed to ensure one caregiver performed a COVID-19 self-screening questionnaire at the beginning of three consecutive shifts when the caregiver displayed symptoms of COVID-19 including a severe cough and failed to ensure the caregiver didn't provide care to postpartum mothers and newborns with symptoms of COVID-19 (A0749). The cumulative effects of these systemic practices resulted in the hospitals inability to ensure the prevention and control of infections. The hospital census was 410 patients.

Based on medical record review, staff interview, and facility policy review, the facility failed to ensure staff completed a COVID-19 self-screening questionnaire to provide early detection of illness among caregivers, helping to prevent the spread of illness. This had the potential to affect postpartum mothers and newborns receiving care.

Findings include:

A list of all facility staff members that tested positive for COVID-19 from 07/01/20 through 11/16/20 was reviewed on 11/17/20 at 11:00 AM. Two caregivers, Staff D, Postpartum Assistant Nurse Manager and Staff E, Postpartum Clinical and Clerical Assistant, were noted to be positive for COVID-19. According to the lab results, the specimen for Staff D was collected on 11/09/20 and resulted positive for COVID-19 on 11/10/20. The specimen for Staff E was collected on 11/07/20 and resulted positive for COVID-19 on 11/09/20.

Staff A, The Director of Quality Management, and Staff B, Infection Preventionist, were interviewed on 11/19/20. According to Staff A, the facility developed a tool called COVID Pass that requires all caregivers to answer COVID-19 health screening questions prior to beginning their shift. The tool is intended to prevent staff from coming to work with symptoms of COVID-19, thereby preventing the spread of the virus. Staff A further explained that managers are sent a daily email that lists all direct reports, whether or not COVID Pass has been completed, and if their direct reports have been cleared to work. Staff A was asked to provide written information on this self-screening tool.

The facility protocol for COVID Pass, including a sample daily report sent to managers, was reviewed on 11/20/20 at 12:40 PM. COVID Pass involves using a smartphone or computer to answer health symptom screening questions prior to coming to work. According to the corporate communication plan, the COVID Pass tool launched on 09/09/20. The communication stated, all caregivers will be expected to complete COVID Pass daily, prior to reporting to any facility campus for their shift. The goal of the tool is to reduce the number of caregivers from coming to work when ill or symptomatic. Caregivers who report symptoms, such as fever, severe cough or shortness of breath, will not be cleared to work and should follow the normal call off procedure. The tool further prompts staff to contact the COVID-19 Caregiver Hotline (Employee Health) to have their symptoms evaluated.

An example of an email generated to a manager was also reviewed. It read:

Dear (Manager's Name),

Your COVID Pass Daily Report for 11/18/20

A Chart with the headings, Name, Email, Cleared To Work?, Date Submitted across the top was noted. The names of the manager's direct reports were listed under name, then their email address, whether or not the direct report was cleared to work, and the date and time the direct report submitted their COVID Pass. If the COVID Pass was not submitted, the Cleared to Work? column read "not submitted."

Staff A was interviewed on 11/30/20 at 11:00 AM. He/She revealed that all managers receive this report every 24 hours for the previous day. As an example, on 11/19/20 a manager would receive a report for 11/18/20.

The COVID Pass self-screening tool was reviewed on 11/23/20 at 02:00 PM. The questionaire asks caregivers if they are experiencing any of the following symptoms:
* Fever greater than 100.4 degrees Fahrenheit
* Severe cough that started or has gotten worse in the last 48 hours
* Shortness of breath that started in the last 48 hours
* Muscle aches that started or has gotten worse in the last 48 hours
* In the last 48 hours have you felt significantly more tired than usual
* New loss of taste or smell
* Chills that are new or are getting worse

If caregivers answer yes to any of the questions, they are not cleared to work and are instructed to call Employee Health for an evaluation.

Staff D was interviewed on 11/24/20 at 01:00 PM. He/She reported symptoms of nasal congestion and headache that began on 11/04/20. Staff D reported having a medical history of seasonal allergies treated with daily allergy medication. Staff D revealed that the symptoms of his/her seasonal allergies were identical to the COVID-19 symptoms that began on 11/04/20. Staff D further revealed that it wasn't until receiving a call from his/her roommate on the morning of 11/09/20 stating that the roommate had tested positive for COVID-19, that Staff D suspected the symptoms he/she had been having for the past 6 days could be symptoms of COVID-19. Staff D reported immediately leaving work and calling Employee Health to be tested. Staff D denied any close contact with co-workers while having COVID-19 symptoms. He/She also denied performing any direct patient care. Staff D stated, "I usually stay in my office. I eat there and work there." Staff D reported wearing all required personal protective equipment (PPE) while working. Staff D also reported completing the COVID Pass tool daily.

Staff E was interviewed on 11/24/20 at 03:20 PM. Staff E stated he/she believed he/she had a "bad cold." Staff E reported congestion, headache, and a cough that he/she described as "horrendous" over the last few days he/she worked. Staff E was asked if he/she completed the COVID pass tool prior to working and he/she replied that he/she had not completed the required self-screening tool. Staff E stated, "I did not fill that out. It was new to us." Staff E reported providing care to patients the week of 11/01/20 and also reported wearing the required PPE while working. Staff E reported being sent home by the manager the evening of 11/06/20 due to his/her cough.

The Postpartum Manager, Staff F, was interviewed on 11/24/20 at 04:00 PM. Staff F was asked if he/she received the COVID Pass daily report for his/her direct reports the week of 11/01/20. Staff F stated he/she thought he/she had deleted the emails. Staff F further revealed Staff E reported to him/her that he/she did not complete the COVID Pass self-screening tool. Staff F confirmed that he/she sent Staff E home due to his/her cough.

The personnel record for Staff E was reviewed on 11/23/20. Staff E was hired as a Clinical Clerical Assistant on 08/01/94. Among other tasks, the orientation documentation revealed he/she received training in taking vital signs of adult patients and newborns.

Postpartum staffing and census sheets for 11/04/20, 11/05/20/ and 11/06/20 were reviewed on 11/30/20. According to the staffing sheets, Staff E was assigned to rooms 19-26 from 07:00 AM to 07:00 PM. Review of the medical records of the 8 patients assigned to Staff E revealed he/she took the temperatures of the moms and newborns. The staffing sheet on 11/05/20 revealed Staff E worked from 07:00 PM to 11:00 PM where he/she was assigned rooms 10-18. Review of the medical records of the patients in the nine rooms revealed Staff E took the temperatures of moms and newborns. Review of the staffing sheet on 11/06/20 noted Staff E worked from 07:00 AM to 07:00 PM and was assigned the Newborn Nursery and rooms 19-26. Again, review of the medical records of patients in the eight rooms revealed Staff E took temperatures of both moms and newborns.

Staff A was interviewed on 12/01/20 at approximately 04:00 PM. It was confirmed there was no evidence of a self-screening tool for Staff E. It was also confirmed that the caregiver was permitted to care for patients for three consecutive days with a cough that the staff member him/herself described as "horrendous."