HospitalInspections.org

Based on observation, interview, and document review, the facility failed to follow Minnesota Executive Order 20-51 and Centers for Disease Control (CDC) screening guidelines to actively screen staff upon entering the facility. This had the potential to impact all patients, visitors, and staff at the facility.

Findings include:

The Minnesota Executive Order 20-51 https://www.leg.state.mn.us/archive/execorders/20-51.pdf dated 5/5/20, directs, "Facilities must conduct active health screening of all staff (e.g., providers, medical assistants, support staff, environmental services staff) at the beginning of each shift, patients, and visitors entering the facility, to assess for signs and symptoms of COVID-19. Screening must include assessment for symptoms associated with infection, as recommended in CDC." CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings updated 5/18/20, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html directs, "Screen all HCP at the beginning of their shift for fever and symptoms consistent with COVID-19. Actively take their temperature and document absence of symptoms consistent with COVID-19. If they are ill, have them keep their cloth face covering or facemask on and leave the workplace."

On 6/3/20, at 10:15 a.m. the entrance conference was held with the chief nursing officer (CNO) and vice president of hospital operations (VPHO)-A. They verified the hospital had numerous cases of COVID-19 present in the hospital.

On 6/3/20, at 12:05 p.m. at the main entrance desk, security officer (SO)-A was interviewed, and described screening visitors by asking questions about COVID-19 symptoms, and whether they had contact with other people diagnosed with COVID-19. SO-A stated he did not physically take temperatures. SO-A stated after screening he asked where the visitors were going, and then provided them a sticker that was labeled with the date, and visit destination. SO-A stated he only screened visitors and vendors, not facility staff. Receptionist (R)-A was also present at the desk, and clarified that they screened all non-employees before entry.

On 6/3/20, at 12:42 p.m. an emergency department technician (EDT)-A was asked about staff screening. EDT-A stated he knew patients were screened prior to entry, but he was not screened daily before his shift. EDT-A could not remember for certain, but thought a while back when coronavirus first started he had possibly been screened once. EDT-A could not remember details on what this screening consisted. EDT-A stated he was told to monitor himself for signs of illness.

On 6/3/20, at 12:48 p.m. registered nurse (RN)-A was interviewed and stated she was not getting screened before work. RN-A remembered when she logged into the computer, there used to be a warning that would come up stating because she was logging in at work, she was attesting that she did not have symptoms of COVID-19. RN-A explained there was nothing she had to do, such as check or click the message, but it was just a warning that popped up. RN-A could not remember if the message was still coming up when she logged in, stating maybe it was not there anymore, or it was possible that she did not notice the message anymore because she was used to it, and there was nothing she had to actively do with the warning.

On 6/3/20, at 12:02 p.m. the CNO and infection prevention manager (IFM)-A were interviewed and explained the hospital had current restrictions in place for visitors, and allowed them only for certain conditions (i.e. end of life patients). The hospital had only two doors into the hospital visitors could use, the main entrance and the Emergency Department (ED). The receptionist then provided a "Wellness Screening Tool" to each visitor and had them complete it, which was used to screen for symptoms of COVID-19. A copy of the screening tool was provided.

The A M Health Wellness Screening Tool dated 5/13/20, identified the screening applied to visitors, contractors, and employees, and outlined several yes or no answered questions including presence of fever, new cough, chills, known or suspected COVID-19 exposure, or exposure to chickenpox, measles or pertussis (whooping cough). The form continued with writing which read, "If YES to any of the above, you are not [bold font] allowed to visit."

The CNO explained there were no physical temperature checks completed for visitors as nothing from the Centers for Disease Control (CDC) directed a hospital had to do so, and IPM-A stated active screening doesn't specifically indicate measuring for a temperature to be completed. They continued the interview and explained the process for HCW screening. The hospital had "about six doors or so" where employees could enter the campus, and the staff were then to sign off electronically using an attestation form indicating they were free of symptoms of COVID-19. A copy of the attestation screen(s) was provided which provided two statements; one used on the time clock and one used on the electronic medical record system. These read as follows:

"Epic message: If you are on site, by logging in, you attest you have no flu-like symptoms. If you have acute respiratory symptoms (e.g. fever (100), cough, or difficulty breathing) please leave work, notify your leader, and contact EOHS [telephone number listed]."

"Kronos message: If you have flu-like symptoms, please leave work and call EOHS [telephone number listed]."

The CNO and IPM-A stated these attestations were used for both direct and non-direct care roles for health care workers (HCW) in the hospital campus, and the staff should be completing them each day they report for work on-campus. No physical temperature checks or monitoring of the hospital's HCW were completed. They expressed they were unaware how or if audit(s) were being completed on the attestations to ensure employees were following the process consistently or correctly, as the Employee Health department "oversees that." The CNO voiced this had been the hospital' system for active screening since COVID-19 restrictions and guidance started. Further, CNO and IPM-A explained they had been listening to the weekly Minnesota Department of Health (MDH) calls pertaining to the need to conduct active screening which had led to "lots of discussion" on it, however, there had been no "system decision that we are moving to that operation" as there were "some challenges" including staffing of screening stations.

A hospital policy on active screening of HCW and visitors was requested; however, none was ever provided. During follow-up interview on 6/3/20, at 2:47 p.m. the CNO verified the hospital had no policies or procedures "in writing" for active screening of visitors and/or HCW. Further, the hospital would be "starting an audit process" of the attestation verifications for HCW to ensure they were being completed correctly.


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