HospitalInspections.org

Based on observation and interview, and document review, the facility failed to actively screen staff and visitors at the point of entry in accordance with the Centers for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS) COVID-19 guidance. This deficient practice had the potential to affect all patients, visitors and staff of the CAH.

Findings include:

Observation on 4/9/20 at 10:30 a.m. upon entrance to the facility, a receptionist (R)-A was seated just inside the main entrance. R-A asked respiratory screening questions related to COVID-19 and if survey staff had any temperature. R-A failed to actively screen for a temperature upon survey entrance to the facility.

Interview on 4/9/20 at 10:56 a.m. with the director of nursing (DON) and the infection control preventionist (ICP) identified all visitors were screened by questionaire when entering the facility. The receptionists who were assigned to perform the screening at the main entrance or ER entrance were to ask all patients and visitors the screening questions. The DON stated staff would use other entrances into the facility. Staff were expected to self-screen at home daily prior to entering the facility and not actively screened prior to working their shift.

Interview with the registered nurse (RN)-A on 4/9/20, at 11:45 a.m., stated the facility staff asked patients who presented to the emergency room (ER) if they had any respiratory symptoms or had been exposed to someone with COVID-19. RN-A confirmed the staff did not check patient temperatures at the entrance and waited until staff completed the assessment in an ER room to check temperatures. RN-A stated during the day hours staff directed patients who had respiratory symptoms to report to the respiratory clinic located in the parking lot. RN-A indicated the ER had designated a respiratory room for patients who had COVID-19 symptoms after hours. The RN-A confirmed the facility had no active COVID-19 screening process for employees.

Interview with the health unit coordinator (HUC) on 4/9/20, at 12:00 p.m., stated patients who presented to the ER pressed the buzzer and HUC responded and met them at the desk by the double doors. HUC asked them if they had symptoms of COVID-19 and checked their temperature. HUC confirmed if the patient had an outpatient appointment (outpatient department was located through the double doors by the ER) she instructed the patient to go directly to the outpatient department and confirmed she did not check their temperatures prior to sending them there. HUC confirmed the facility did not screen their employees prior to starting their shift. HUC confirmed the facility had not been actively screening visitors who entered the building in the front entrance.

Observation on 4/9/20 at 12:07 p.m., of the emergency room (ER) corridor with the ER secretary (HUC)-A and ICP identified HUC-A's station was adjacent to the locked ER entrance. When a patient arrived, she would ask them the screening questions. If the patient answered no, they would be taken into an ER bay. At that point nursing staff would take patient vitals including a temperature and respiratory status. The ER entrance was also used for patients requiring chemotherapy infusions. When those patients arrived, they announced themselves on the intercom. They were allowed entry. A nurse would come to greet them, then escort them through the infusion center doors to the left of the ER entrance. Once inside the infusion center, nursing staff would then take all vitals. Patients using the ER entrance were not screened prior to entrance unless they self-declared a temperature or other potential COVID-19 signs or symptoms. Critical patients requiring emergency medical services (EMS) were brought thru a different entrance for EMS only, directly to an exam room. The ICP agreed without active screening prior to entry for patients not requiring EMS services, there was a high risk of potential exposure to healthcare workers, approved visitors, and other patients with COVID-19.

Interview with the registered nurse RN-B on 4/9/20, at 12:10 p.m., confirmed the facility did not screen their employees prior to starting their shift. RN-B stated employees were expected to stay at home when ill.

Review of the 4/9/20, updated Emerging Threats-Acute Respiratory Syndromes Coronavirus-Ortonville policy identified:
1) Patients were to be screened for travel history and symptoms using the screening process.
2) A visitor who had been screened and approved was to limit their movement within the facility and to be screened by using the Visitor Screening Documentation of Appendix B- Employee Screening Log. Sections for Name, Fever 100.4 degrees or higher, respiratory symptoms, contact with a COVID positive person, and travel. There were sections for "OK to work?", "Exclude from duty/send home", and the initials of the person completing the screening.
3) Staff were to use the Employee Screening Log to gather and record employee criteria to determine suitability for work prior to their shift.
There was no mention assigned staff were to actively screen patients by taking temperatures and assessing for respiratory signs and symptoms for staff or visitors at the point of entry.

Interview with the Clinic Nurse Supervisor (CNS) on 4/9/20, at 1:00 p.m., confirmed the outpatient clinic had been undergoing construction and confirmed the facility did not actively screen the construction workers for COVID-19 symptoms when they reported to work.

Interview and document review on 4/9/20 at 1:00 p.m., with the DON and ICP stated staff were to self- monitor at home before coming to work. Once they arrived at work, they were not required to use a specific door. Active screening was never performed for staff prior to entry. The DON also agreed all patients (unless critical), staff, and visitors should be actively screened for symptoms prior to entrance through the ER. The facility had not yet implemented employee screening logs for staff.








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Review of the facility policy titled Acute Respiratory Syndromes Coronavirus revised on 4/9/20, identified an employee screening log which listed employee name, if they had a fever of 100.4 or more, any symptoms of shortness of breath, cough or a sore throat. The log asked in the last 14 days, have you returned from travel to a level three country, disembarked from a cruise, had contact with two or more minutes with a person who was positive with COVID-19 in the last 14 days.