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Based on a review of facility documentation, medical records (MR) and staff interview (EMP), it was determined that the facility failed to ensure that a physician order was written for patients that were transferred to an acute hospital for one of ten medical records reviewed (MR1).

Findings include:

1. Review of "Medical Staff Rules And Bylaws" dated 1/9/17, revealed " ...13. (a) Patients shall be discharged from the hospital only on the written order of the patient's attending physician... ."

2. Review of MR1 revealed nurses note dated 7/1/2017, "PICC line flushed ... noted catheter leaking ... dressing removed ... fresh blood noted ... leaking around hub ... catheter partially out ... NP notified ... transfer to Children's Hospital ... ." Further review of MR1 revealed no documentation of a physician order to transfer the patient.

3. An interview with EMP3 on July 7, 2017, at approximately 10:30 AM confirmed the above findings. EMP3 stated, "No, I don't see an order. Let me check one other place." EMP3 continued reviewing MR1 and noted, "I don't know why they did not write the order. The NP documented in the progress note that the patient was to be transfered to the hospital but that is not the same as writing an order to transfer the patient. There isn't an order that I can find." EMP3 had EMP2 look at MR1. At approximately 11:00 AM, EMP2 also confirmed there was no order.

Based on review of facility documentation, observation, and employee interview (EMP), it was determined that the facility failed to follow the facility policy to maintain safe and sanitary characteristics.

Findings include:

1. Review of The Children's Home of Pittsburgh Policy, "Housekeeping Policy...Utility Rooms" reviewed January 12, 2017, revealed, "Purpose: To provide guidelines to Hospital staff regarding the proper use of the utility rooms available to the staff for both 'dirty' and 'clean' items. Defining the specific purposes of the 'dirty' and 'clean' utility rooms will promote the cleanliness of the Nursery and to help reduce the potential for spreading infection. Policy Detail: A. Dirty Utility Room: 1. The room will be used for the following purposes: a. temporary storage of dirty linen and trash, until it can be properly disposed; b cleaning and disinfecting of contaminated non-disposable equipment: ...The cart for clean equipment may not enter this room, but should be kept outside the door to immediately receive the newly disinfected items. ...Responsibility for maintenance of this room shall be the Service Aides in collaboration the the Housekeepers, under the general direction of the Assistant Director and/or Facility Manager. ..."

2. Tour of the Purple unit on July 7, 2017, at approximately 12:00 PM revealed a room with signage that indicated, "Dirty Utility". On the door of the room another sign indicated, "Biohazard". The room contained a large blue bin, which held bags of soiled linen. The room also contained one metal shelving unit that stored clean toys, boxes of tissues, boxes of wet wipes, bottles of saline, opened and unopened packages of diapers, containers of soap and blue pads.

In addition, there were three isolate straps that were on the counter, and there were three white bath tubs placed next to the hopper. A large bottle of cleaning detergent was sitting inside the hopper.

3. During an interview at the time of the tour, EMP4 was asked if the bath tubs and isolate straps were clean. EMP4 confirmed that the items were clean and also confirmed that there were clean and dirty items in the dirty utility room.