HospitalInspections.org

Based on record reviews, interviews, and review of the hospital's infection control policies and procedures related to COVID - 19 requirements, the hospital failed to quarantine 1 of 1 patients per its own infection control policies for screening for COVID - 19 and and isolation and quarantine for Persons Under Investigation (PUI) for COVID - 19. (Patient 5)

The findings are:

Facility policy, titled, "Respiratory Screening", reads, "Have you recently had any of the following symptoms? Cough, cold, runny nose or sore throat, shortness of breath or difficulty breathing, fever (100.4 F or higher with no fever reducing medication), chills or repeated shaking with body aches or muscle pain, vomiting and/or diarrhea, headache, new loss of taste or smell ...".

Patient 5
On 9/15/2020 at approximately 3:30 PM, review of the electronic medical record of Patient 5 with RN 1 revealed Patient 5 was admitted on 9/13/2017 for Schizophrenia and a past medical history of Atrial Fibrillation, Hypertension, and Hypothyroidism. Patient 5 resides on Lodge E. Review of nurse progress notes dated 07/25/2020 at 2:37 PM revealed, "It is reported that patient has been heard coughing some ...On call NP notified. No new orders at this time."

Review of the nurse progress notes for Patient 5 dated 7/26/2020 at 6:18 AM revealed, "Patient frequently trying to clear his throat and sounding more congested. Refused to allow staff to get vital signs. Color sallow and paler than usually. Will continue to monitor and try to get vital signs." Review of the LPP progress note dated 7/26/2020 at 9:45 AM by MD(Medical Doctor) 2 revealed, "Patient was reported by charge nurse to have been coughing for the past few days ...Two of the patients in this unit has tested positive for Covid-19. He is scheduled to get tested tomorrow. Patient was sitting calmly in the day area and did not appear to be in any distress ...". Patient was not placed on quarantine on 07/26/2020.

Review of a nurse progress notes dated 7/27/2020 at 5:02 AM revealed, "Patient continues to have frequent coughing spells but non productive ...Color paler than usual. Continues to say he is OK when asked how he feels. Will continue to monitor and report changes. Review of a nurse progress note dated 7/27/2020 at 3:04 PM revealed, "Patient continues with cough ...Refused vital sign check and Covid-19 testing. Lodge LPP and nurse manager (notified) of symptoms. No orders received." Review of a nurse progress note dated 7/27/2020 at 5:20 PM revealed, "Transfer note: ...Started having a runny nose, non productive coughing, and sneezing over the last three days; pallor generalized, congestion ...declined to wear a face mask. Has spent time sitting in day room." Patient transferred to Lodge G COVID isolation".

In a face to face interview with MD 2 on 9/16/2020 at 3:15 PM in the conference room, MD 2 revealed, "If you suspect patient has COVID-19 is to order a test and isolate the patient." After reviewing the 7/26/2020 progress note for Patient 5 , MD 2 verified he/she did not order a COVID-19 test on 7/26/2020, nor isolate or transfer the patient out of Lodge E. MD 2 stated, "No, I wouldn't isolate a patient with a cough, and I didn't transfer him because he had no temperature."

A face to face interview with MD 1 on 9/16 at 2:30 PM in the conference room revealed that the "expectation is that patients with suspected COVID-19 should be placed in designated COVID - 19 isolation. Medical staff were updated in July 2020 on COVID- 19 guidelines, and we shifted to please call me if anyone is on call and suspects a patient has COVID." MD 1 provided copies of the advisory memo and attached policies that all LPP ' s received dated 7/10/2020. Review of the memo and guidelines reads "Evaluation and triage of patients suspected of being infected with COVID-19... The division of inpatient services has developed policies and procedures intended to decrease the risk of virus transmission in our inpatient facilities. You should familiarize yourself these documents (website provided ...covid-19-resources.) ...The COVID-19 screening form (found in Avatar) should be completed. Either the RN or the LPP can complete the form, although the results must be relayed to the LPP on call ...If patient ' s presentation is sufficiently concerning to warrant a COVID-19 test, they should be considered a "Person Under Investigation" for COVID-19 infection. The patient should be immediately placed in a mask and staff should initiate contact precautions when providing treatment. PUI ' s should be moved to the isolation unit ...if you need additional guidance, you should contact the medical director at (phone number)."