HospitalInspections.org

Based on observation, staff interview, review of The Centers for Disease Control and Prevention (CDC) guidelines, and review of facility documents, it was determined that the facility failed to ensure infection control practices were implemented to mitigate the spread of COVID-19.

Findings include:

1. The facility failed to ensure active surveillance and prevention to avoid sources and transmission of infection and communicable disease in accordance with facility policy and The CDC Guidelines. (Cross Refer Tag V0750)

Based on observation, staff interviews, and review of facility policy, it was determined that the facility failed to ensure COVID-19 screening of patients and visitors was conducted to prevent the transmission of infectious and communicable diseases in accordance with facility policy and The Centers for Disease Control and Prevention Guidelines.

Findings include:

Reference #1: Facility policy titled, Patient Visitor Policy, states, "... All visitors must: [bullet] be screened upon entry for symptoms of illness, [bullet] arrive wearing a facemask ... NOTE: Visitors will not be allowed to stay if screening shows signs of illness and/or temperature above 100.4 ... and as per NJ [New Jersey] travel advisory restrictions. ..."

Reference #2: The Centers for Disease Control and Prevention document titled COVID-19 Interim Infection Prevention and Control recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic Infection Control Guidance, updated July 15, 2020, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations. html, states "... Screen everyone (patients, HCP, visitors) entering the healthcare facility for symptoms consistent with COVID-19 or exposure to others with SARS-CoV-2 infection and ensure they are practicing source control. [bullet] Actively take their temperature and document absence of symptoms consistent with COVID-19. Fever is either measured temperature =100.0°F or subjective fever. [bullet] Ask them if they have been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection. ..."

1. During a tour of the Emergency Department (ED) on 10/19/20 at 10:40 AM, there were three (3) individuals sitting in the waiting room wearing masks and socially distancing. Staff #24 was sitting at the reception desk behind a Plexiglas shield. Staff #10 identified the three (3) individuals in the waiting room as visitors who came with patients that were being seen in the ED treatment area.

a. Staff #10 stated that the staff does not screen patients and visitors for symptoms of COVID-19 upon entering the ED entrance or while in the ED waiting room. Staff #10 stated that when a patient comes into the waiting room they sign in and are usually taken through the ED treatment door and screened there. This surveyor asked Staff #10 if there would ever be a time that patients would sit in the waiting room with the other people prior to being screened. Staff #10 stated, "yes" and that patients may have to wait in the waiting room if they were busy.

b. Staff #10 confirmed that the three (3) visitors in the ED waiting room had not received a temperature screening and were not asked the COVID screening questions.

c. Upon interview on 10/19/20 at 10:45 AM, Staff #24 was asked if he/she performs a COVID screening on patients and visitors that come in through the ED entrance, Staff #24 answered, "no."

2. During a tour of the Emergency Department (ED) on 10/20/20 at 9:55 AM, there were two (2) individuals sitting in the waiting room wearing masks and socially distancing. Also present was Staff #2. Staff #10 stated that the two (2) individuals in the waiting room were visitors who came with patients who were being seen in the ED treatment area.

a. Upon interview on 10/20/20 at 10:00 AM, Staff #24 stated that the visitors were not screened for COVID upon entering the building or while in the waiting room.

b. Upon interview on 10/20/20 at 10:00 AM, Staff #10 stated that when a patient comes into the waiting room they sign in and are taken through the ED treatment door and are screened there.

3. Upon interview on 10/20/20 at 10:30AM, Staff # 1 confirmed that visitors were not being screened for COVID in the ED waiting room.

4. On 10/20/20 at 2:20 PM, Staff #1 stated that everyone is screened and are not allowed into the building unless they pass the screening. Staff #1 and Staff #2 stated that the facility does not document the COVID screening results performed at the entrance of the facility for visitors, patients, and staff. This is not in accordance with CDC guidelines (Reference #2) which state to document the absence of symptoms consistent with COVID-19.




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Based on medical record review, review of facility policy, and staff interview, it was determined that the facility failed to ensure that the patients discharge planning includes linking the patient to post discharge care and, when needed, a safe transition from the hospital to a post-discharge destination.

Findings include:

1. The facility failed to ensure that outpatient facilities receive current treatment information for patients requiring outpatient services. (Cross Refer to Tag A-0813, Part A)

2. The facility failed to ensure that the patient or patient's caretaker receives clear and complete medical information at discharge related to needed outpatient services or follow up. (Cross Refer to Tag A-0813, Part B)


36492

A. Based on medical record review, staff interview, and facility policy review, it was determined that the facility failed to ensure that the hospital discharge plan included outpatient treatment information for six (6) of ten (10) medical records (Medical Record #2, #4, #6, #7, #9, and #10).

Findings include:

Reference: Facility document titled, Assessment and Reassessment of Patients, states, "... Care managers and social workers document their reassessments, coordination of care activities, and the final discharge plan in the medical record. ..."

1. On 10/20/20 at 11:15 AM, Medical Record #2 was reviewed with Staff #19 and Staff #2. The following was revealed:

a. There is documentation that Patient #2 had a history of End Stage Renal Disease and received inpatient hemodialysis on 1/8/20, 1/10/20, 1/14/20, and 1/16/20; and was discharged from the hospital on 1/16/20.

b. There is no evidence that the Case Manager or Social Worker contacted the patient's outpatient hemodialysis facility to verify availability and acceptance of Patient #2 prior to discharge from the hospital. The medical record lacked evidence that outpatient hemodialysis services were arranged.

c. There is no evidence that the nursing home was notified of Patient #2's last hemodialysis treatment, or where Patient #2 would be receiving outpatient hemodialysis services after discharge from the hospital.

d. Upon interview, Staff #19 confirmed that Patient #2 was to continue outpatient hemodialysis upon discharge from the hospital. Staff #19 stated that outpatient hemodialysis was arranged but not documented in the medical record.

2. On 10/20/20 at 11:20 AM, Medical Record #4 was reviewed with Staff #7. The following was revealed:

a. There is documentation that Patient #4 had a history of End Stage Renal Disease and received inpatient hemodialysis prior to discharge on 1/4/20.

b. There is no evidence that the Case Manager or Social Worker followed up with the patient's outpatient hemodialysis facility to verify availability and acceptance of Patient #4 prior to discharge from the hospital. The medical record lacked evidence that outpatient hemodialysis services were arranged for Patient #4.

c. There is no evidence that the nursing home was notified of Patient #4's last hemodialysis treatment, or where Patient #4 would be receiving outpatient hemodialysis services after discharge from the hospital.

d. Upon interview, Staff #7 confirmed that Patient #4 was to continue outpatient hemodialysis upon discharge from the hospital. Staff #7 stated that outpatient hemodialysis was arranged but not documented in the medical record.

3. On 10/20/20 at 11:30 AM, Medical Record #6 was reviewed with Staff #19 and Staff #21. The following was revealed:

a. There is documentation that Patient #6 had a history of End-Stage Renal Disease and received inpatient hemodialysis on 2/12/20, 2/13/20, 2/15/20, 2/17/20, 2/18/20, 2/19/20, 2/21/20, 2/24/20, and 2/26/20; and was discharged from the hospital on 2/27/20.

b. There is no evidence that the Case Manager or Social Worker followed up with the patient's outpatient hemodialysis facility to verify availability and acceptance for Patient #6 prior to discharge from the hospital. The medical record lacked evidence that outpatient hemodialysis services were arranged.

c. There is no evidence that the nursing home was notified of Patient #6's last hemodialysis treatment or where Patient #6 would be receiving outpatient hemodialysis services after discharge from the hospital.

d. Upon interview, Staff #19 confirmed that Patient #6 was to continue outpatient hemodialysis upon discharge from the hospital. Staff #19 stated that outpatient hemodialysis was arranged but not documented in the medical record.

4. On 10/20/20 at 11:50 AM, Medical Record #7 was reviewed with Staff #7. The following was revealed:

a. There is documentation that Patient #7 had a history of End-Stage Renal Disease and received inpatient hemodialysis on 12/28/19, 1/2/20, 1/4/20, 1/7/20, 1/9/20, and 1/10/20; and discharged from the hospital on 1/10/20.

b. There is no evidence that the Case Manager or Social Worker followed up with the patient's outpatient hemodialysis facility to verify availability and acceptance for Patient #7 prior to discharge from the hospital. The medical record lacked evidence that outpatient hemodialysis services were arranged.

c. There is no evidence that the skilled nursing facility was notified of Patient #7's last hemodialysis treatment or where Patient #7 would be receiving outpatient hemodialysis services after discharge from the hospital.

d. Upon interview, Staff #7 confirmed that Patient #7 was to continue outpatient hemodialysis upon discharge from the hospital. Staff #7 stated that outpatient hemodialysis was arranged but not documented in the medical record.

5. On 10/20/20 at 11:55 AM, Medical Record #9 was reviewed with Staff #7. The following was revealed:

a. There is documentation that Patient #9 had received hemodialysis treatment beginning with this hospitalization on 1/29/20, 1/31/20, 2/3/20 and 2/5/20; and discharged from the hospital on 2/6/20.

b. Medical Record #9 lacked evidence that the Long Term Acute Care Hospital (LTACH) was notified that Patient #9 was being discharged from the hospital on 2/6/20.

c. Medical Record #9 lacked evidence that the LTACH was notified of Patient #9's last hemodialysis treatment prior to discharge.

d. Medical Record #9 lacked evidence that staff had confirmed Patient #9's post-discharge hemodialysis services.

6. On 10/20/20 at 2:00 PM, Medical Record #10 was reviewed with Staff #7. The following was revealed:

a. There is documentation that Patient #10 had a history of End Stage Renal Disease and received inpatient hemodialysis on 10/7/20 and 10/9/20; and discharged from the hospital on 10/10/20.

b. There is no evidence that the Case Manager or Social Worker followed up with the patient's outpatient hemodialysis facility to verify availability and acceptance for Patient #10 prior to discharge. The medical record lacked evidence that outpatient hemodialysis services were arranged.

c. Patient #10 was discharged to home with family care. There is no evidence that Patient #10's family member was notified of his/her last hemodialysis treatment, or where Patient #10 would be receiving outpatient hemodialysis services after discharge from the hospital.

d. Upon interview, Staff #7 confirmed that Patient #10 was to continue outpatient hemodialysis upon discharge from the hospital. Staff #7 stated that outpatient hemodialysis was arranged but not documented in the medical record.

7. On 10/20/20 at 11:30 AM, Staff #19 and Staff #21 confirmed the above findings. Staff #19 stated that when there is a patient starting hemodialysis, the case manager will set up outpatient hemodialysis for the patient and document that in the chart. Staff #19 stated that when a patient is already receiving outpatient hemodialysis center the patient usually returns to that facility.

a. Staff #21 stated that the case manager should speak with the patient's current outpatient dialysis facility and notify them that the patient is being discharged and will be returning to their facility. Staff #21 stated that the communication between the hospital and the outpatient hemodialysis facility should be documented in the patient's medical record.


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B. Based on medical record review for (9) of ten (10) Medical Records (Medical Record #2, #3, #4, #5, #6, #7, #8, #9, and #10) and staff interview, it was determined that the facility failed to ensure that the patient or patient's caretaker receive discharge instructions for outpatient services.

Findings include:

1. Medical Record #2 contained discharge instructions, dated 1/16/20, that were sent to the nursing home with Patient #2.

a. The discharge instructions did not include information related to Patient #2's continued need for hemodialysis as an outpatient. The discharge instructions did not include:

(i) What arrangements were made for outpatient hemodialysis.

(ii) Where Patient #2's next outpatient hemodialysis treatment is located.

(iii) When the next outpatient hemodialysis treatment is scheduled.

(iv) The date of Patient #2's last hemodialysis treatment.

b. Medical Record #2 lacked evidence that a Universal Transfer form was completed and sent to the nursing home with Patient #2 upon discharge on 1/16/20.

c. On 10/20/20 at 11:15 AM, Staff #19 confirmed the above findings.

2. Upon interview on 10/20/20 at 11:20 AM, Staff #7 stated that a Universal Transfer form should be completed when patients are being transferred to another health care facility. Staff #7 stated that staff should include all necessary information from the patient's admission on the transfer form.

a. Upon request on 10/20/20 at 2:30 PM, Staff #1 could not provide a policy and procedure regarding the use and completion of the Universal Transfer Form.

3. Medical Record #3 contained discharge instructions dated 2/21/20, that were sent to the inpatient rehab facility with Patient #3.

a. The "Discharge Instructions" were signed by two (2) registered nurses. The area on the patient signature line that states "Date/Time" was left blank.

(i) Medical Record #3 indicates under the section titled "Physical Exam" that Patient #3 is alert and oriented to person, place, time and situation.

(ii) Patient #3's "Discharge Instructions" lack an indication of the reason why he/she did not sign the discharge instructions.

b. The discharge instructions did not include information related to Patient #3's continued need for hemodialysis as an outpatient. The discharge instructions did not include:

(i) What arrangements were made for outpatient hemodialysis.

(ii) Where Patient #3's next outpatient hemodialysis treatment is located.

(iii) When the next outpatient hemodialysis treatment is scheduled.

(iv) The date of Patient #3's last hemodialysis treatment.

c. On 10/20/20 at 11:15 AM, Staff #7 confirmed the above findings.

4. Medical Record #4 contained discharge instructions dated 1/5/20, that were sent to the nursing home with Patient #4.

a. The area on the signature line that states "Patient/Legal Guardian Signature ... Date/Time" was left blank.

b. There is documentation that states "... Discharge Diagnosis: Acute GI bleeding; Anemia"

(i) There is no evidence that the patient was given education related to Acute GI bleeding or Anemia within the patient's discharge instructions.

c. The discharge instructions did not include information related to Patient #4's continued need for hemodialysis as an outpatient. The discharge instructions did not include:

(i) What arrangements were made for outpatient hemodialysis.

(ii) Where Patient #4's next outpatient hemodialysis treatment is located.

(iii) When the next outpatient hemodialysis treatment is scheduled.

(iv) The date of Patient #4's last hemodialysis treatment.

d. The medical record contained a universal form dated 1/4/20, that states, "... UNIVERSAL TRANSFER FORM ... (Items 1 - 29 must be completed) ..."

(i) Twenty-five (25) of twenty-nine (29) item lines were not answered and left blank.

e. On 10/20/20 at 11:40 AM, Staff #7 confirmed the above findings.

5. Medical Record #5 contained undated "Discharge Instructions". The area on the signature line that states, "Patient/Legal Guardian Signature ... Date/Time" was left blank.

a. Medical Record #5 lacked evidence that a Universal Transfer form was completed and sent to the nursing home with Patient #5 upon discharge.

b. On 10/20/20 at 11:50 AM, Staff #7 confirmed the above findings.

6. Medical Record #6 contained undated "Discharge Instructions". The area on the signature line that the patient signs acknowledging they have received patient education and instruction was signed by two (2) registered nurses with documentation that states, "unable to sign/(illegible)." The area on the signature line that states "Date/Time" was left blank.

a. There is documentation that states, "... Discharge Diagnosis: End stage renal disease; 2. Anemia; Chest pain; ... Fluid overload, ..."

(i) There is no evidence that the patient or caretaker was given education related to End stage renal disease, Anemia, or fluid overload within the patient's discharge instructions.

b. The section titled "Follow Up:" contained a person's name.

(i) There is no evidence of who the person is.

(ii) The areas titled, "Address:" and "When:" were left blank.

c. Medical Record #6 lacked evidence that a Universal Transfer form was completed and sent to the nursing home with Patient #6 upon discharge.

d. On 10/20/20 at 11:30 AM, Staff #19 confirmed the above findings.

7. Medical Record #7 contained discharge instructions, dated 1/9/20, that were sent to the skilled nursing facility with Patient #7.

a. The area where the patient signs the discharge instructions acknowledging they have received patient education and instruction was signed by two (2) registered nurses with documentation that states, "patient refused." The area on the signature line that states "Date/Time" was left blank.

b. The discharge instructions did not include information related to Patient #7's continued need for hemodialysis as an outpatient. The discharge instructions did not include:

(i) What arrangements were made for outpatient hemodialysis.

(ii) Where Patient #7's next outpatient hemodialysis treatment is located.

(iii) When the next outpatient hemodialysis treatment is scheduled.

(iv) The date of Patient #7's last hemodialysis treatment.

8. Medical Record #8 contained undated "Discharge Instructions:" that were signed by the family. The area on the signature line that states, "Date/Time" was left blank.

a. On 10/20/20 at 11:40 AM, Staff #7 confirmed the above findings.

9. Medical Record #9 contained undated "Discharge Instructions". The area on the signature line that states, "Patient/Legal Guardian Signature ... Date/Time" was left blank. Patient #9 was discharged to a Long Term Acute Care Hospital.

a. There is documentation that states, "... Discharge Diagnosis: Acute on chronic diastolic (congestive) heart failure; Acute urinary tract infection; Chronic kidney disease (CKD); H/O type 2 diabetes mellitus... End-stage renal disease."

(i) There is no evidence that the patient was given education related to Acute urinary tract infection; Chronic kidney disease (CKD); H/O type 2 diabetes mellitus... End-stage renal disease in the patient's discharge instructions.

b. The discharge instructions did not include information related to Patient #9's continued need for hemodialysis.

c. Medical Record #9 lacked evidence that a Universal Transfer form was completed and sent to the LTACH with Patient #9 upon discharge.

d. On 10/20/20 at 11:55 AM, Staff #7 confirmed the above findings.

10. Medical Record #10 contained discharge instructions dated 10/10/20 that were given to Patient #10 on discharge to home.

a. There is documentation that states, "Assessment/Plan ...1. Hypercalcemia, 2. Hyperparathyroidism, 3. ESRD -End stage renal disease on renal replacement therapy, 4. CHF exacerbation, and 5. Thrombocytopenia."

(i) There is no evidence that the patient was given education related to Hyperparathyroidism, ESRD - End Stage Renal Disease on renal replacement therapy, CHF exacerbation, and Thrombocytopenia within the patient's discharge instructions.

b. The discharge instructions did not include information related to Patient #10's continued need for hemodialysis as an outpatient. The discharge instructions did not include:

(i) What arrangements were made for outpatient hemodialysis.

(ii) Where Patient #10's next outpatient hemodialysis treatment is located.

(iii) When the next outpatient hemodialysis treatment is scheduled.

(iv) The date of Patient #10's last hemodialysis treatment.

c. On 10/20/20 at 2:00 PM, Staff #7 confirmed the above findings.

11. On 10/20/20 at 2:30 PM, a policy or procedure for the Completion of Discharge instructions was requested. Staff #1 and Staff #2 stated they did not have a policy or procedure.