HospitalInspections.org

Based on medical record review, review of facility policy, staff interview, and review of the Center for Disease Control and Prevention (CDC) guidance, the facility failed to implement its Emergency Department COVID-19 Testing Protocol for one (Patient #1) of 10 medical records reviewed. This had the potential to affect every patient who presents to the emergency department. The average daily census of the emergency department is 70.

Findings include:

Review of the facility policy titled "Emergency Department COVID-19 Rapid Testing Protocol," revised 11/18/20, revealed all patients entering the Emergency Department will be screened for COVID-19 and, if indicated, tested for COVID-19 using the Accula testing platform, or a send out COVID-19 Polymerase Chain Reaction (PCR) test to an appropriate laboratory. The procedure indicated:

1) Patients will be screened at triage and will be identified if they meet any of the following criteria:
· Experiencing any of the listed COVID-19 symptoms including: fever or chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea.
· Identified as high risk due to exposure to COVID-19, positive contact, or is in a quarantine period
· Resides in a congregate living facility
· Is hypoxic, as evidenced by an oxygen saturation of < 92%.
2) Nurse performing triage will place order for facility COVID STAT under WTBS* (waiting to be seen) protocol order for any patient who meets the defined criteria.
3) If patient meets any of the criteria they will be tested upon being placed into the exam room. Testing is not to take place until patient is placed into room.

Review of an email from Staff H on 08/20/21 at 9:11 PM revealed the body of the email read:
Update
We have received a good amount of the Accula rapid test that does pick up the COVID variants. We will use this until we receive more of the Cepheid tests of which we are accustomed.
To use the Accula swabs:
1) It is a nasal swab, not nasopharyngeal. Please swab the inside of the nares. Refer to instructions placed by the assignment sheet.
2) It is to be placed back into its paper/plastic wrapper and sent to lab double bagged.
3) Per lab this test takes approximately thirty minutes
We are now able to reimplement the nurse driven COVID testing protocol if felt it is warranted.
We are to use this test for all COVID testing at this time. No more sending out testing. Giving a decisive result is more beneficial to the community than letting someone wait for a few days thinking that they do not have COVID whilst spreading it.

Review of the record revealed Patient #1 arrived at the facility's emergency department on 08/25/21 at 8:49 PM and was discharged home on 08/25/21 at 9:50 PM with discharge instructions for headache and toothache, and referral information for dental clinics. An emergency department (ED) Physician Form dated 08/25/21 at 8:54 PM documented Patient #1's chief complaint was headache and associated symptoms were listed as headache, body aches, chills, and denies shortness of breath but does have occasional dry cough. Also has toothache. Patient #1's temperature on arrival was 37.3 degrees Celsius/99.1 degrees Fahrenheit. Staff D documented the following:
28-year-old presents complaining of a headache and dental pain. The patient woke up this morning with a headache and it feels similar to when she/he had COVID a while ago and she/he wanted to make sure she/he did not get COVID again. No nausea or vomiting. She/he took some Tylenol for her/his headache. She/he is unable to get into see a dentist for her/his tooth pain. Nothing seems to make it better or worse. No other complaints.
Patient was treated for her/his headache with Toradol in the emergency department. Staff D documented educating Patient #1 it is very unlikely that she/he recontracted COVID after already having a diagnosed case of COVID. Staff D suspected the headache is more likely related to her/his dental infection or possibly other viral etiology. At this point Staff D would not test her/him for COVID. If she/he is concerned she/he can get an outpatient COVID test. She/he was prescribed Pen-Vee K for her/his dental pain and given dental referral. Discharge problem listed toothache and headache.

The medical record of Patient #1 contained a form titled Ticket to Treat Screening Process which contained a questionnaire regarding COVID-19. Question #1 was Are you experiencing any of the following symptoms of COVID-19: fever or chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headaches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea? Patient #1 answered this question yes. Question #3 asked Have you been exposed to others with suspected or confirmed COVID-19 in the last 14 days? Patient #1 answered yes.

The ED Triage Assessment for Patient #1 dated 08/25/21 at 8:50 PM contained a COVID-19 screening section. Cough, chills, muscle pain and headache were listed as unexplained symptoms reported by Patient #1 during the COVID-19 screening.

Interview on 10/21/21 at 8:29 AM. Staff I reviewed Staff I's documentation in the medical record and verified Staff I documented Patient #1 complained of headache, body aches, chills and occasional dry cough. Also had a toothache.

Interview on 10/21/21 at 9:54 AM, Staff E reported Patient #1 should have received a COVID test based on the facility's Emergency Department COVID-19 Rapid Testing Protocol.

Review of the CDC guidance titled "Symptoms of COVID-19," issued 02/22/21, revealed people with these symptoms may have COVID-19: fever or chills, cough, fatigue, muscle or body aches, headaches.

Review of the CDC guidance titled "COVID-19 Testing Overview," issued 10/27/21, revealed under the heading Who Should Get Tested For Current Infection to include people who have symptoms should be tested.

This deficiency substantiates Substantial Allegation OH00125758.