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Based on review of medical records and staff interviews the hospital failed to reassess the patient's discharge plan when factors affecting the discharge occurred for 1 of 3 sampled patients discharged from the psychiatric unit (5).

Review of Patient #5 record revealed the patient was discharged on 01/14/2011 at 1010 to a Skilled Nursing Facility (SNF). Record review revealed the patient's admission to the receiving SNF was refused by the parent (responsible party) and the patient was returned to the hospital's Emergency Department (ED) on 01/15/2011 at 0248. Record review revealed the patient was discharge to home on 01/15/2011 at 0948.

Interview on 02/22/2011 at 1440 with the Social Worker (SW) responsible for discharge planning on the Senior Behavioral Medicine Unit (SBMU) revealed this SW did not audit patient charts for evaluation of discharge planning process. Interview revealed "Nursing audits the charts but I am not sure if they are looking at what I'm doing."

Interview on 02/23/2011 at 0830 with the SW responsible for Patient #5's discharge to the SNF from the SBMU on 01/14/2011 revealed she was not aware the patient's admission to the SNF was refused by the parent (responsible party) and she was not aware that the patient was discharge home from the hospital's ED on 01/15/2011.

Interview on 02/23/2011 at 0930 with the Director of Case Management confirmed the Senior Behavioral Medicine Unit was not under the oversight of the hospital's Case Management Director.

Based on review of hospital policy and procedures, closed medical records and staff interviews, the staff failed to document in the patient's medical record that a list was presented to the patient or to the individual acting on the patient's behalf for 1 of 3 sampled patients discharged from the psychiatric unit (5).

Closed record review on 02/24/2011 for Patient #5 revealed a 63-year old patient was transferred from a Skilled Nursing Facility (SNF) to the hospital's Emergency Department for evaluation of increasing agitation and "overly sexual behaviors" toward the SNF staff and other residents. Record review revealed the hospital admitted the patient for evaluation on 01/08/2011 to the psychiatric unit (Senior Behavioral Medicine Unit) with a diagnosis of Paranoid Schizophrenia and mild retardation. Record review of a Social Worker note, dated 01/12/2011 at 1115, revealed, "Telephone call to admissions coordinator for (Facility A) to notify of tentative d/c (discharge) on Friday. She (admissions coordinator) stated that they may not have a bed available for pt (patient) on Friday. She requested that SW (Social Worker) call her Friday morning to confirm and check status...Family did not pay for bed hold...Awaiting bed offers... " Record review of Nursing Discharge Documentation dated 01/14/2011 at 1006 revealed, "Discharge to (Facility Z) Salisbury" on 01/14/2011 at 1010. Record review revealed no written documentation a list of SNFs was presented to the patient or family.

Interview on 02/23/2011 at 0845 with the social worker assigned to patient #5 confirmed there was no written documentation a list of SNFs was presented to the patient or family.

NC00070376