HospitalInspections.org

Based on observation, interview, and record review, the facility failed to ensure patients received care in a safe setting.
Upon arrival to Health South (Encompass Hospital) on December 1, 2020 at 08:45 AM we entered in the main entrance, these surveyors were screened by a Health South employee who had a mask on that was improperly positioned below her nose. The screener did not ask any questions or verify that the surveyors saw the additional questions about state travel, that was on a board next to the temperature scanner. The Hospital screener Susan Wiley did not ensure that the surveyors properly sanitized their hands before entering the main part of the hospital.


Staff (RN # 58) was observed 12/01/20 at 10:22 am in the patient rooms hallway donning PPE to enter a patient room. She already had a white paper mask that was covered by a blue fabric mask of her own. She proceeded to place a teal N-95 mask on top of the other 2 masks.
" When interviewed 12/01/20 at 10:22 am staff (RN # 58) was asked about why the N-95 mask was layered on top of other masks she did not immediately respond but looked puzzled.
" Vickie Westerson Chief Nursing Officer (CNO #52) observed her at the same time and redirected the nurse to place the N-95 mask on her face not on top which #58 did.
" Vickie Westerson (CNO #52) stated the N-95 mask should always be worn against the skin with no other masks underneath it.

Staff person (CNA #16) was observed 12/01/20 at 12:55 am delivering a meal tray to room 138 (patient # I) an isolation room. Patient I was on precautions as a presumed Covid-19 patient, awaiting test results. Room 138's door was marked with two precaution signs:

" Droplet Precautions - Wear GOWN, GLOVES and MASK before entering room. Remove and discard before leaving the room. Preform hand hygiene before entering or exiting room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.
" Contact Precautions - Wear GOWN and GLOVES prior to touching the patient. Remove and discard in the room before exiting. Preform hand hygiene before entering and exiting the room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.

She entered the room with a blue surgical mask on and without gloves, gown, hair cover or an N-95 mask, placed the tray on the over-bed table, told the patient his tray was there and left. She did not cleanse hands before exiting the room. She began walking down the patient hallway and was asked to stop for an interview by this surveyor.

Interview:
When interviewed at 1:00 pm Health Technician (Tech) #16 stated:

" She "really didn't see the sign" on the door "because I just went in and out in a minute to drop off a tray."
" She was asked about hand hygiene and she said she "would wash my hands when I get to the bathroom sink," point toward the bathroom nearer the nursing desk.
" She hadn't thought about cleaning her hands in the patient room or using the hand sanitizer dispensers on the walls in the hallway that she had passed.
" She did not know the diagnosis of the patient on precautions and thought if she knew he was suspected of having Covid-19 or had it she probably would have been more cautious, even though she knows she should always be cautious.
" She then used the wall mounted hand sanitizer.

Patient #H was observed 12/01/20 at 1:15 pm laying in room 118, an isolation room. Patient H was on precautions as a presumed Covid-19 patient, awaiting test results. A female visitor was sitting at his bedside speaking to him. The visitor was wearing a face mask but no other PPE. Room 118's door was marked with two precaution signs:

" Droplet Precautions - Wear GOWN, GLOVES and MASK before entering room. Remove and discard before leaving the room. Preform hand hygiene before entering or exiting room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.
" Contact Precautions - Wear GOWN and GLOVES prior to touching the patient. Remove and discard in the room before exiting. Preform hand hygiene before entering and exiting the room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.

Interview:
When interviewed 12/01/20 at 1:00 pm the Room 118 visitor stated:
" She "saw the sign on the door but didn't pay attention to it. I thought it was for staff."
" No one had offered her PPE and/or instructed her on its use and location in the room.
" She visited on 11/30/20 and no one had mentioned protective items to her then either.
" "There was a nurse in here a little while ago and she never said anything to me."

Interview with Registered Nurse (RN Unit Charge Nurse #60) at 12/01/20 at 1:10 pm. Nurse #60 was asked if there were safeguards to assure visitors knew about isolation precautions and precaution requirements for those they may be visiting who are on precautions especially suspected Covid-19.
" She stated "The lobby receptionist has a sheet with which rooms have precautions and what patients are them. She tells the visitors, so they know there are precautions" When asked how a visitor would get PPE she stated, "The Tech can get PPE for them."
I then asked how and when a Tech would be aware there was a visitor.
" She paused and then said, "They would see them when they pass the room."
I asked what prevents a visitor from entering the room before someone notices they are there.
" She again paused and said 'Nothing."

Interview with RN Unit Charge Nurse #60 at 12/01/20 at 1:20 pm
" RN stated she "Checked and the receptionist did not have a list of precaution patients or rooms."
She was asked if she was aware room 118 currently had a visitor with no PPE.
" She responded she was not aware but the nurse in that hall should be aware.

Interview 12/01/20 at 2:00 pm
" Vickie Westerson Chief Nursing Officer (CNO #52) and Chief Executive Officer (CEO) stated visitors were not to enter rooms without being properly equipped by staff.

Record Review:

Record review 12/02/20 at 1:50 pm revealed that patients H and I in precaution rooms 118 and 138 were swabbed for Covid-19 on 11/30/20, and awaiting results.

The hospital failed to provide a sanitary environment to avoid sources and transmission of infections and communicable diseases as evidenced by the following.

Based on observation, interview, and record review, the facility failed to ensure patients received care in a safe setting.
Upon arrival to Health South (Encompass Hospital) on December 1, 2020 at 08:45 AM we entered in the main entrance, these surveyors were screened by a Health South employee who had a mask on that was improperly positioned below her nose. The screener did not ask any questions or verify that the surveyors saw the additional questions about state travel, that was on a board next to the temperature scanner. The Hospital screener Susan Wiley did not ensure that the surveyors properly sanitized their hands before entering the main part of the hospital.


Staff (RN # 58) was observed 12/01/20 at 10:22 am in the patient rooms hallway donning PPE to enter a patient room. She already had a white paper mask that was covered by a blue fabric mask of her own. She proceeded to place a teal N-95 mask on top of the other 2 masks.
" When interviewed 12/01/20 at 10:22 am staff (RN # 58) was asked about why the N-95 mask was layered on top of other masks she did not immediately respond but looked puzzled.
" Vickie Westerson Chief Nursing Officer (CNO #52) observed her at the same time and redirected the nurse to place the N-95 mask on her face not on top which #58 did.
" Vickie Westerson (CNO #52) stated the N-95 mask should always be worn against the skin with no other masks underneath it.

Staff person (CNA #16) was observed 12/01/20 at 12:55 am delivering a meal tray to room 138 (patient # I) an isolation room. Patient I was on precautions as a presumed Covid-19 patient, awaiting test results. Room 138's door was marked with two precaution signs:

" Droplet Precautions - Wear GOWN, GLOVES and MASK before entering room. Remove and discard before leaving the room. Preform hand hygiene before entering or exiting room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.
" Contact Precautions - Wear GOWN and GLOVES prior to touching the patient. Remove and discard in the room before exiting. Preform hand hygiene before entering and exiting the room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.

She entered the room with a blue surgical mask on and without gloves, gown, hair cover or an N-95 mask, placed the tray on the over-bed table, told the patient his tray was there and left. She did not cleanse hands before exiting the room. She began walking down the patient hallway and was asked to stop for an interview by this surveyor.

Interview:
When interviewed at 1:00 pm Health Technician (Tech) #16 stated:

" She "really didn't see the sign" on the door "because I just went in and out in a minute to drop off a tray."
" She was asked about hand hygiene and she said she "would wash my hands when I get to the bathroom sink," point toward the bathroom nearer the nursing desk.
" She hadn't thought about cleaning her hands in the patient room or using the hand sanitizer dispensers on the walls in the hallway that she had passed.
" She did not know the diagnosis of the patient on precautions and thought if she knew he was suspected of having Covid-19 or had it she probably would have been more cautious, even though she knows she should always be cautious.
" She then used the wall mounted hand sanitizer.

Patient #H was observed 12/01/20 at 1:15 pm laying in room 118, an isolation room. Patient H was on precautions as a presumed Covid-19 patient, awaiting test results. A female visitor was sitting at his bedside speaking to him. The visitor was wearing a face mask but no other PPE. Room 118's door was marked with two precaution signs:

" Droplet Precautions - Wear GOWN, GLOVES and MASK before entering room. Remove and discard before leaving the room. Preform hand hygiene before entering or exiting room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.
" Contact Precautions - Wear GOWN and GLOVES prior to touching the patient. Remove and discard in the room before exiting. Preform hand hygiene before entering and exiting the room. Use dedicated patient equipment or clean and disinfect multi-use with hospital-approved disinfectant wipes.

Interview:
When interviewed 12/01/20 at 1:00 pm the Room 118 visitor stated:
" She "saw the sign on the door but didn't pay attention to it. I thought it was for staff."
" No one had offered her PPE and/or instructed her on its use and location in the room.
" She visited on 11/30/20 and no one had mentioned protective items to her then either.
" "There was a nurse in here a little while ago and she never said anything to me."

Interview with Registered Nurse (RN Unit Charge Nurse #60) at 12/01/20 at 1:10 pm. Nurse #60 was asked if there were safeguards to assure visitors knew about isolation precautions and precaution requirements for those they may be visiting who are on precautions especially suspected Covid-19.
" She stated "The lobby receptionist has a sheet with which rooms have precautions and what patients are them. She tells the visitors, so they know there are precautions" When asked how a visitor would get PPE she stated, "The Tech can get PPE for them."
I then asked how and when a Tech would be aware there was a visitor.
" She paused and then said, "They would see them when they pass the room."
I asked what prevents a visitor from entering the room before someone notices they are there.
" She again paused and said 'Nothing."

Interview with RN Unit Charge Nurse #60 at 12/01/20 at 1:20 pm
" RN stated she "Checked and the receptionist did not have a list of precaution patients or rooms."
She was asked if she was aware room 118 currently had a visitor with no PPE.
" She responded she was not aware but the nurse in that hall should be aware.

Interview 12/01/20 at 2:00 pm
" Vickie Westerson Chief Nursing Officer (CNO #52) and Chief Executive Officer (CEO) stated visitors were not to enter rooms without being properly equipped by staff.

Record Review:

Record review 12/02/20 at 1:50 pm revealed that patients H and I in precaution rooms 118 and 138 were swabbed for Covid-19 on 11/30/20, and awaiting results.