Failure to Ensure Proper Two-Step Tuberculin Skin Testing on Admission
Penalty
Summary
The facility failed to ensure that baseline tuberculin skin testing (TST) was conducted using the two-step method within the required time frames for two of three residents reviewed. For one resident, the first-step TST was administered and read at the hospital prior to admission, but there was no documentation of a second-step TST being administered or read after admission. For another resident, the first-step TST was given and read within the appropriate time frame, but the second-step TST was read four hours earlier than the required 48 to 72-hour window. Interviews with nursing staff and the infection preventionist in training confirmed that the facility's process was to administer the first-step TST upon admission and the second-step one to three weeks later, with both steps to be read 48 to 72 hours after administration. However, documentation and timing errors were identified in the records reviewed. The Director of Nursing was unable to locate documentation of a second-step TST for one resident and acknowledged the early reading of the second-step TST for another. Facility policy and state guidance require a two-step TST for new admissions unless there is documentation of a previous positive TB test, with specific timing for administration and reading.