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Based on medical record review, policy review, and staff interview, the facility failed to comply with the Mississippi State Department of Health 'Tuberculosis Patient Discharge Regulation' requirement to obtain written approval from the Tuberculosis (TB) Program prior to discharging Patient #1 to a nursing home, one (1) of five (5) patients reviewed.


FINDINGS INCLUDE:


Review of the Mississippi Department of Health Tuberculosis Manual -Topic: "Management of Tuberculosis Disease" Section 5 page 40, Revision Date February 2016 revealed: "Guidelines for high risk areas includes long term care facilities. When patients with known or suspected TB are to be placed in or returned to areas which are high risk for TB transmission, certain precautions must be taken. Documentation of risk and permission to enter/return to high risk areas shall be obtained. The decision should a joint one based on criteria stated and the joint clinical judgment of the clinician and the public health nurse responsible for the care of the TB case or suspect. Prior written approval from the Tuberculosis Program is required for all TB cases or suspects."

Review of the facility's "Infection Prevention and Control, Tuberculosis Exposure Control Plan" (dated 02/22/16) revealed that it did not include the requirement "Prior written approval from the Tuberculosis Program is required for all TB cases or suspects placed into nursing homes."

Patient #1, a 63-year-old non-verbal male, was admitted to the hospital facility from a nursing home on 11/4/16. Review of the Admission History and Physical revealed: "Chief Complaint: Tuberculosis (TB) skin test converted. The patient has a tracheostomy and supposedly had a negative skin test a month ago, now his skin test is positive. He has a chest x-ray from the nursing home which indicates he has an infiltrate in the left lung. The patient is being admitted for evaluation of TB. There has been no fever or antibiotics in the nursing home suggesting this is pneumonia. Chest x-ray: Portable here, tracheostomy, left Port-A-Catheter, minimal atelectasis of the left lower lung which is a different interpretation of the x-ray from the nursing home. IMPRESSION: 1. Left lower lung infiltrate. 2. Possible TB. 3. Seizures. 4. Diabetes type 2. 5. Hypertension. 6. Coronary artery disease. 7. Nonverbal. 8. Heart failure. 9. Phlebitis of both legs. 10. Tracheostomy."

Review of the Admission Orders revealed: "Diagnoses - Cough (Possible TB), Left lung infiltrate, positive TB skin test, - Respiratory Precautions and normal saline IV (intravenous) at 100 cc (cubic centimeters) an hour; Isolations Precautions for rule-out TB Airborne; Isolation Cabinet and Isolation TB mask, small..."

Review of the Hospitalist Progress Notes revealed: "On 11/5/16 the patient was having increased secretions from tracheostomy and fever, temperature 101.2 degrees Fahrenheit (F), pulse 129, respirations 24, and blood pressure (B/P) 106/67. On 11/6/16 having increased secretions via tracheostomy, temperature 97.4 degrees F, heart rate 97, respirations 22, and B/P 123/80. Plan to continue intravenous antibiotics and aggressive suctioning.... 11/7/16 Sputum cultures positive for Staph aureus, afebrile, trach had large secretions requiring aggressive suctioning. Plan: Labs in a.m. and continue intravenous antibiotics."

The patient was discharged to return to the nursing home on 11/09/16.

The discharge summary contained the following information. Discharge Diagnoses: 1. Pneumonia with staph, non-MRSA, resolving. 2. Tracheostomy. 3. Seizure disorder. 4. Diabetes Type II. 5. Hypertension. 6. Coronary artery disease. 7. Anemia, TB ruled out. The patient had TB cultures. All three were negative for any TB. X-ray showed infiltrate and atelectasis in the left lower lobe. The patient was started on IV antibiotics. Sputum was sent for culture which did come back positive for staph aureus and negative for MRSA. The patient was placed on antibiotics. The patient does nave a tracheostomy and was noted to have a large amount of secretion which requires frequent suctioning. Again, the patient will have to have frequent suctioning at discharge at the nursing home to be noted in the discharge summary and on the orders for frequent suctioning.

This case was discussed with the Chief Operations Office on 11/17/16 at 1:35 p.m.

Based on medical record review, policy review, and staff interview, the facility failed to develop and implement policies that complied with the Mississippi State Department of Healths' Tuberculosis patient discharge regulation requirement to obtain written approval from the Tuberculosis (TB) Program prior to discharging a patient to a nursing home. This affected Patient #1, one (1) of five (5) patients reviewed.


Findings include:


Cross Refer to Tag A021 for the facility's failure to develop policies and procedures that addressed the requirement that prior written approval from the TB Program is required for all TB cases or suspects placed into nursing homes.