HospitalInspections.org

Based on document review and staff interview it was determined the facility failed to follow it's policy and procedure for maintaining Contact Isolation Precautions for one (1) of ten (10) medical records reviewed (Patient #2) following a positive finding of head lice on admission. This failure has the potential to put all patients on the unit at risk of infestation.

Findings include:

1. The facility policy entitled "Type and Duration of Precautions Needed for Selected Infections and Conditions", last revised 9/2011, was reviewed on 6/18/14. It lists multiple infection/condition types, the precaution type required and the duration of precaution required. Under the entry for lice, the precaution required is "Contact". Under the duration required is "For twenty-four (24) hours after the start of treatment".

2. The facility policy entitled "Transmission Based Precautions", last revised 12/2010, was reviewed on 6/18/14. It states, in part, under the heading "Contact Precautions, Patient Placement: Single room is preferred; however, patients with the same disease or organism may share a room in unavoidable...", and "Sharing a room with a patient that does not have the same disease or organism should only be considered under extreme circumstances".

3. Patient #2's medical record was reviewed on 6/16/14. The document entitled "Nursing Admission Skin Assessment" dated 4/14/14 revealed the entry "Head lice check: Check done, lice." The Physician's Order sheet dated 4/14/14 revealed the entry "Please give Nix treatment tonight". The two (2) documents entitled "Close Observation Sheet" dated 4/14/14 and 4/15/14 revealed entries by multiple staff members indicating Patient #1's location every fifteen (15) minutes throughout these two (2) days. The entries noted that location as either in her room, in the Dayroom, in the gym, or in the dining room.

4. The Patient Census for the Child Unit dated for the morning of 4/15/14 revealed the room assignment as Patient #1 in room 333 bed 1, and Patient #2 in room 333 bed 2.

5. A telephone interview was conducted with Registered Nurse (RN) #2 on 6/18/14 at 1015. She stated Patient #2 would have been assigned to the semi-private room "on paper" due to registration requirements, but unit protocol for a positive assessment of head lice would have dictated the patient actually sleep in the unit's "Quiet Room" the night following her treatment. She was unable to recall where the patient had actually slept that night.

6. A telephone interview was conducted with Mental Health Technician (MHT) #4 on 6/18/14 at 1000. He agreed he had completed multiple portions of the Close Observation Sheet for Patient #2 during his shift from eleven (11) p.m. to seven (7) a.m. on 4/14/14. He stated if the patient had been sleeping in the Quiet Room, he would have indicated this on his observation entries as "Q.R." He agreed that he had not done so in this case and was unable to recall if the patient had slept in the Quiet Room.

7. An interview was conducted with the Director of Clinical Services, Child/Adolescent Behavioral Health Center on 6/18/14 during which Patient #2's medical record was reviewed. He stated his expectation for a patient admitted with head lice would be to treat the patient and have the patient spend the night in the unit's Quiet Room. He added his expectation of twenty-four (24) hours following treatment before allowing the patient to have a roommate. He agreed, following review of the medical record, that no documentation existed to show that this protocol had been followed. He added he had interviewed numerous staff members and had been unable to find one who recalled the patient sleeping in the Quiet Room following her treatment.