HospitalInspections.org

Based on interview and record review, it was determined that the hospital failed to promote and protect each patients' rights.

Findings include:

The hospital failed to ensure that each patient was given the right to make informed decisions regarding his or her care. (Refer to Tag A-0131)

The hospital failed to provide care in a safe setting. (Refer to Tag A-0144)

Based on observation, interview, and record review, it was determined that the hospital did not ensure that each patient was given the right to make informed decisions regarding his or her care. Specifically, patients were not able to refuse certain treatments. (Patient identifies: 7, 8, 9, and 10)

Findings include:

On 1/3/23, observations were made in the emergency department (ED). During the tour, the facility's decontamination areas were observed. The facility has one decontamination room inside. The surveyor was shown their outside decontamination showers. The showers were located outside the facility exposed to the elements in an alleyway where potentially anyone could walk by. (Note: there were privacy curtains available)

On 1/3/23 at 2:07 pm, an interview was conducted with an ED registered nurse (RN1). He was asked about the decontamination process in the ED and if patients could refuse to be decontaminated. He stated if they just had a suspicion of bed bugs they would give them a choice, but if they saw a bug or knew for sure, the patient could not refuse.

On 1/5/23 at 8:18 am, the director over the ED was interviewed. The director was asked if there were any extreme weather conditions that would deem it unsafe for patients to shower outside. She replied, "absolutely not, no weather conditions justify contaminating the inside." The director was asked if patients could refuse. She stated, no, they cannot refuse and that it was a part of keeping them safe and everyone else safe.

On 1/5/23 at 11:02 am, an interview was conducted with the facility's accreditation manager (AM). The AM was asked if patients could refuse treatment like being decontaminated outside. She stated it was her understanding that if they were competent, they could refuse. It was mentioned that 2 staff members stated that patients could not refuse. She was surprised this was the staff members response. The AM was then asked if there were any extreme weather conditions that they (hospital staff) would deem unsafe for them to shower outside. She stated, "there should be conditions where patients should not shower outside. What if it is below freezing?" She continued, "There is definitely a gap here, from what people are doing and what they should be doing."

A medical record review of patient's 7, 8, 9, and 10 was completed on 1/5/23. There was no documented evidence in 4 out of 4 medical records of patients receiving decontamination services, that each patient gave consent for decontamination, or a choice of another acceptable alternative.

On 1/5/23, the facility's policy titled "Decisions regarding Medical Treatment" was reviewed. The policy read, "Adults may accept or refuse offered health care, or request that healthcare be withdrawn. Health care professionals will honor these choices, whether made by the adult patient directly or through a HealthCare Directive."

By the end of the survey the hospital was unable to provide protocols that were within accepted national guidelines for the treatment and prevention of bedbugs, or any other containment, that required decontamination, and what the hospital's alternative treatment would be if a patient refused.

Based on observation, interview, and record review, it was determined the hospital did not ensure all patients received care in a safe setting. Specifically, there were patient care and treatment concerns, which did not lend to a therapeutic and safe environment. (Patient identifiers: 7 and 10)

Findings include:

On 1/3/23, observations were made in the emergency department (ED). During the tour, the facility's decontamination areas were observed. The facility has one decontamination room inside. The surveyor was shown their outside decontamination showers. The showers were located outside the facility exposed to the elements in an alleyway where potentially anyone could walk by. (Note: there were privacy curtains available.)

On 1/3/23, surveyors requested a list of patients that had been decontaminated showing the dates of service. A list of four names and dates were provided. The weather in Salt Lake City on those days was as follows:

12/13/22, the high was 31, the low was 27
12/21/22, the high was 43, the low was 19
12/23/22, the high was 30, the low was 25
12/31/22, the high was 46, the low was 31

On 1/4/23, the facility's policy on decontamination was requested to determine when a patient should and should not be decontaminated outside. A policy titled; "Bed Bugs Procedure" was provided. The policy read, "Have patient disrobe and shower immediately in their current room. Limit the patient's movement." The facility was asked if they had policies and procedures related to decontamination in the emergency department since there were no showers in the ED rooms. A policy titled; "Hazardous Material Exposure" was provided. The policy did not mention anything about using the outside showers or how to safely decontaminate a patient. No other policy was provided.

A document titled "Decon (decontamination) Tank" was provided with the policies. The document had instructions on who to contact when decontaminating a patient. It stated, "If you have used the decon room for any reason, you must fill out the decon log sheet and fax it to the appropriate number listed on the sheet." The decon logs were requested. No decontamination logs were provided.

On 1/4/23 at 4:27 pm, an interview was conducted with a member of the facility's emergency management team. He was asked if decontamination patients were always decontaminated outside. He replied, if it is a non-hazardous material and assuming they were ambulatory, they wash themselves outside. For something like bed bugs, they shower for around 10 to 20 minutes. If it was snowing or if there were extreme temperature conditions, they would use the indoor showers. He mentioned the hospital should have protocols in place to follow. He stated they do all the decontamination training. He stated that the hospital teaches them to follow the hospital's protocols. He was asked if there was a decontamination log. He stated there should be.

On 1/5/23 at 8:18 am, the director over the ED was interviewed. She was asked if they had any policies on decontamination of patients in the ED. She stated she would have to look and get back to me. The director was asked if there were any extreme weather conditions that would deem it unsafe for patients to shower outside. She replied, "absolutely not, no weather conditions justify contaminating the inside." The director was asked if patients can refuse. She stated, "no", they cannot refuse and that it was a part of keeping them safe and everyone else safe. She was asked if they have a log of patient's that have been contaminated. She stated they do and would get me the last quarter of their decontamination logs. (Note: no policy and procedures were provided, and no decontamination log was provided.)

On 1/5/23 at 9:32 am, an interview with the facility's accreditation manager (AM) was conducted. She stated there were no other policies related to decontamination and there was nothing specific to the ED.

On 1/5/23 at 11:02 am, an interview was conducted with the facility's accreditation manager (AM). The AM was asked if patients could refuse treatment like being decontaminated outside. She stated it was her understanding that if they were competent, they could refuse. It was mentioned that 2 staff members stated that patients could not refuse. She was surprised this was the staff members response. The AM was then asked if there were any extreme weather conditions for which they (the hospital) would deem unsafe for them to shower outside. She stated, "there should be conditions where patients should not shower outside. What if it is below freezing?" She continued, "There is definitely a gap here, from what people are doing and what they should be doing."

A medical record review of patient's 7 and 10 was completed on 1/5/23. There was no documented evidence in 2 out of 2 medical records, where the patients were decontaminated outside, that they were given the risk and benefits of being decontaminated outside in extreme temperatures.

By the end of the survey the hospital was unable to provide protocols that were within accepted national guidelines when utilizing an outdoor shower for decontamination of patients in the treatment and prevention of bed bugs, or any other containment.