Bringing transparency to federal inspections
Tag No.: A0143
Based on a review of facility documentation, and medical records (MR), and staff interviews (EMP), it was determined that the facility failed to ensure patient privacy during case discussion, examination and/or treatment for seven of seven Emergency Department (ED) patients (MR1, MR2, MR3, MR4, MR5, MR7 and MR10) located in the ED hallway.
Findings include:
Review of policy HS-HD-PR-01* Patients' Notice and Bill of Rights and Responsibilities, date December 4, 2015 revealed, "II. SCOPE This policy applies to all United States based UPMC acute care hospitals, acute inpatient rehabilitation facilities, licensed outpatient clinics (hospital based), cancer centers, ambulatory surgical centers and behavioral health programs. ... III. PURPOSE The Patients' Notice and Bill of Rights and Responsibilities is made available to patients, their family members* and representatives via patient information materials and postings. This information shall be posted in registration areas and areas within each service location ... IV. PATIENTS' NOTICE AND BILL OF RIGHTS ... Privacy, Respect, Dignity and Comfort You have a right to: 1. Personal privacy, including: a. during personal hygiene activities, treatments or examinations; b. sharing your personal information only with your consent unless otherwise permitted or required by law; c. deciding if you want your family involved in your care; d. during clinical discussions between you and your treatment team members. ... Staff and Environment You have the right to: 1. Receive respectful care given by competent personnel in a setting that: a. is safe and promotes your dignity, positive self image and comfort; ..."
Review of Policy HAM-PC-ED-23, Nontraditional Bed Utilization in the Emergency Department, last reviewed February 19, 2016, revealed, "... Purpose: Designated nontraditional Emergency Department (ED) treatment sites may be used as a last resort at infrequent periods of high demand for short periods of time to safely manage capacity needs for unexpected patient volume surges. Policy: Key Principles: Consideration for patient safety, privacy, and confidentiality parallels the need for timely and high quality care in a nontraditional ED space. ... Examples of inappropriate patient selection for nontraditional ED spaces: Patients undergoing any treatment which would compromise the patient's dignity, respect or confidentiality. Patients requiring repeated parenteral medication administration Patients with unstable conditions Patients requiring examination of any clothed/covered areas other than distal extremities Patients with profound sensorium, behavioral, or cognitive impairment that is disruptive to patient care Patients requiring a forensic exam Alternative sites are pre-designated, adjacent to licensed sites, in line of care providers' sight. ..."
1. Review of MR1 revealed the patient presented to the UPMC Hamot ED on September 19, 2016, with symptoms of a racing heart and a family request for a psychiatric evaluation. Review of EMS (Emergency Medical Service) documentation revealed, "Upon arrival at Hamot, pt. was wheeled inside to ER hallway bed 14. Pt was assisted to transfer from the stretcher to the bed. Oral report was given and pt care was transferred to nursing staff." Further review of the record revealed the patient was assessed and provided education during the time documented as being in the ED hallway. Review of facility patient tracking documentation revealed that during the care identified, the patient was located in the hallway (11:16 PM on September 19, 2016 to 8:07 AM on September 20, 2016; and 8:11 AM to 8:28 AM on September 20, 2016 for a total of 546 minutes). The patient was admitted to observation status on September 20, 2016, at 9:55 AM.
2. Review of MR2 revealed the patient presented to the UPMC Hamot ED on September 19, 2016, with symptoms of abdominal pain. Nursing documentation, for 11:45 AM revealed, "Assumed care of Pt in hall bed at this time." At 11:55 AM, the physician was documented as being at the bedside. Review of the medical screening exam revealed, "Visit Information: Patient seen on 9/19/2016 11:54:00 AM Nursing documentation reviewed: Yes." Further review of the record revealed the patient was assessed and provided education/discharge instructions during the time documented as being in the ED hallway. The patient was discharged on September 19, 2016, at 3:09 PM. Review of facility patient tracking documentation revealed that during the care identified, the patient was located in the ED hallway (11:29 AM to 3:09 PM for a total of 219 minutes).
3. Review of MR3 revealed the patient presented to the UPMC Hamot ED on September 19, 2016, for evaluation of hypertension Nursing documentation, for 1:38 PM revealed, lab work was drawn as well as an ammonia level collected at 2:45 PM Review of the medical screening exam revealed, "Visit Information: Patient seen on 9/19/2016 1:56:00 PM Nursing documentation reviewed: Yes." Nursing documentation for 3:56 PM revealed, "patient resting comfortably on alternative hallway bed." Further review of the record revealed the patient was assessed and provided education during the time documented as being in the ED hallway. The patient was discharged on September 19, 2016, at 6:27 PM. Review of facility patient tracking documentation revealed that during the care identified, the patient was located in the ED hallway (1:08 PM to 6:25 PM for a total of 317 minutes).
4. Review of MR4 revealed the patient presented to the UPMC Hamot ED on September 19, 2016, for right upper quadrant pain. Nursing documentation for 4:14 PM revealed, "Assumed care of Pt from triage in hallway bed at this time." Nursing documentation further placed the physician at the bedside at 4:18 PM and 5:00 PM. Nursing documentation revealed discharge instructions were provided at 5:29 PM. Review of the medical screening exam revealed, "Visit Information: Patient seen on 9/19/2016 4:10;00 Nursing documentation reviewed: Yes." Further review of the record revealed the patient was assessed and provided education/discharge instructions during the time documented as being in the ED hallway. The patient was discharged at 5:31 PM on September 19, 2016. Review of facility patient tracking documentation revealed that during the care identified, the patient was located in the ED hallway (4:10 PM to 5:30 PM for a total of 80 minutes).
5. Review of MR5 revealed the patient presented to the UPMC Hamot ED on September 19, 2016, for nausea, vomiting and abdominal pain. Review of the medical screening exam revealed, "Visit Information: Patient seen on 9/19/2016 9:02:00 PM Nursing documentation reviewed: Yes." Review of the record revealed, "(11:08 PM) Admission to Medicare ... Bed type Non-Monitored Bed." Nursing documentation revealed ongoing assessments, medication administration and discharge instructions occurring between the patient's admission to observation status until discharge to home on September 20, 2016, at 9:36 AM. Review of facility patient tracking documentation revealed that during the care identified, the patient was located in the ED hallway (September 19, 2016 10:11 PM to September 20, 2016, 9:54 AM for a total of 703 minutes).
6. On November 10, 2016, between 1:05 PM and 1:15 PM, EMP2 confirmed the aforementioned findings for MR1, MR2, MR3, MR4 and MR5.
8. Review, at approximately 8:45 AM on November 10, 2016, of the Grievance/Complaint Report for August 2016-Current, printed on November 8, 2016, revealed, documentation of a patient's parent filing a grievance with the facility regarding care a patient (MR7) received on October 20, 2016. Review of the documentation revealed that the patient was placed in a hallway bed; and discussions took place with nursing staff and physician staff regarding the patient's care, which the patient and parent were not comfortable with.
Review, at approximately 11:30 AM on November 23, 2016, of MR7, date of service October 20, 2016, did not reveal documentation that the patient was given a hallway bed assignment in the facility's ED.
At approximately 2:24 PM on November 23, 2016, EMP4 confirmed that the patient in MR7 was placed in a hallway bed in the facility's ED for approximately 146 minutes.
7. Review, at approximately 11:55 AM on November 23, 2016, of MR10, date of service August 12, 2016, revealed, "... ED Nurses Note ... 08/12/16 05:00 pm ... Patient placed in hallway bed at this time. ..." Further review of the patient's medical record could not determine if this patient received the entirety of his/her medical care in the hallway.
At approximately 1:07 PM on November 23, 2016, EMP4 confirmed that the patient was in a hallway bed for 44 minutes, from 4:30 PM until 5:14 PM.