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Patient comes back to ED in scrubs and works an entire shift as a temp
She claimed she had lost ID badge — staff took her word
At 9 p.m. on March 5, a woman who had been a patient in the ED at St. Joseph's Hospital in Tampa, FL, returned there in scrubs and claimed to be a temporary worker. Although she had no ID badge, staff accepted her story that she had lost it. She was allowed to enter the ED and worked for 10 hours as a patient care technician.
Apparently, her familiarity with ED lingo and the layout of the department helped convince the staff she was whom she claimed to be. However, it soon became apparent that she couldn't take temperatures or read blood pressure. She was told to shadow another worker, but she completed her shift. The next day she returned, and asked to be readmitted to the ED — as a patient.
"This is bizarre on a lot of levels," says Gregory Henry, MD, FACEP, risk management consultant for Emergency Physicians Medical Group in Ann Arbor, MI. While no patients appeared to have been harmed, Henry says they certainly could have been. Also, "she might have slowed down the process," he notes. "If you have to get something done in two minutes and they fail to call in the right personnel, then that's a problem."
In addition, Henry says, the door was wide open to potential violations of the Health Insurance Portability and Accountability Act (HIPAA). "This was ethical and moral deception," Henry says. "Even if staff did not release [confidential patient] information or she did not pose a clear and present [patient safety] threat, patients in the ED have a right to expect that their problems and lives, which are personal, will be handled as such."
Grena Porto, RN, MS, ARM, CPHRM, senior vice president with Marsh, a risk and insurance services firm based in Philadelphia, put it even more succinctly: "This incident makes you think of a Marx Brothers movie," she says.
'No badge, no work'
In an ideal situation, Henry says, this phony temp would never have begun her shift. "At that moment in time [when she claimed to have lost her ID], the policy should have been no badge, no work," he asserts. "Or at the very least, they would have to get some form of temporary ID from the manager, who could first check to records to see if you were who you claimed to be."
Incidentally, he adds, this policy alone is insufficient because "no one looks at badges." Henry tells the story of a medical school colleague who pasted in a picture of Mickey Mouse on his ID badge and was never caught in four years. "What's more, someone could steal a badge," he notes.
Perhaps the more important question to answer is "Who is this person, and what is their training?" he says. If someone is there for their first day of work, he notes, they should go through orientation. As an ED manager, "you ought to know who your team is," he says. "Where I work, we know everybody — even the cleaning people."
Port adds, "First of all, if you don't know someone, you can't just say, 'Oh well, you lost your badge — especially in the ED, where you have a lot of people coming and going."
It's not unusual for a legitimate member of the staff to show up and not be known to the staff — especially in a large hospital, she says. "But having said all of that, you still have to have some process," Porto says. "We have to be able to verify who you are, or send you home."
Photo identification is best, she says, because anyone can simply give the name of an employee. "Anyone who shows up and does not have valid ID should be deemed not ready for work," says Porto.
That rule, she continues, may have a few exceptions. "If one of my nurses I know on sight does not have their ID, and I am a nurse manager and need nurses, they might not go home," she concedes.
Acting on suspicions
In Porto's opinion, when it was clear she couldn't perform basic tasks, the other employees should have told their supervisor, but the decision to have them shadow other workers was useful, she says. "It was an appropriate step in terms of removing them from circumstances in which they could hurt anyone; and at that time of night, there may not have been a lot of offices open where they could call someone."
Once that shift was completed, "I think I certainly would have gotten in touch with the manager," she says. "I would also pass the information on to the day shift, so that she would not be assigned again."
But Henry maintains that the staff should have recognized that the worker was an impersonator. When the phony temp had trouble performing basic services, he says, "Didn't that ring a little bell? If you can't take a blood pressure or a temperature, what are you doing there?"
If you do discover someone like this working in your ED, he continues, you have to take definitive action — for example, notify the authorities. "Have them escorted out by security," he suggests. In fact, he says, calling the local police is not a bad idea, either. "After all, they're trespassing," he explains. "No one is invited to just wander through the bowels of the hospital."
For Henry, having this individual shadow other workers makes no sense. "I might have said to my supervisor, 'There's a training problem here,'" he says.
In addition, he says, when an impostor is discovered, "I would go back and check every patient they have seen, to make sure that something 'funky' hasn't been done." If a problem is discovered, he says, "Take care of it now. If a patient is mad, talk to them; if that person put in a Foley catheter, be sure the patient does not have torn urethra, and so on."
No exceptions, please
The issue of someone masquerading as a hospital employee is not unusual, which makes it even more important for ED managers to have strong policies in place, notes Porto. "The biggest problem is doctors, who often do not have photo IDs," she notes. "They may walk in and start reading a patient's chart, but no one will question them because they often are afraid to."
How do you overcome this problem? "All attendings ought to have photo ID, and that ID should be renewed when they renew their privileges and presented on demand," Porto says. "In fact, whether you are a doctor, a parking lot attendant, or a nurse on the floor, you should be prepared to do that."
Above all, experts agree, you should go the 'extra mile' once you sense something is amiss. "I actually think the staff acted in a reasonably appropriate manner — except for that initial decision to let the temp in," says Porto. "They were somewhat alert to the fact that there was something a little strange going on."
As for St. Joseph's, the administrators are conducting their own investigation, strengthening badge enforcement, and educating staff about how to deal with unfamiliar colleagues, according to local press reports.1
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