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Based on interviews and medical record review it was determined that the facility did not ensure the policy and procedure for discharge planning was implemented for 1 (#2) for 3 sampled patients. This practice does not ensure a safe or effective discharge.

Findings include:

According to the policy and procedure for Patient Discharge Procedure Policy# 8-008,
revised 12/08 revealed under definitions, discharge order- a written or telephone order from attending physician and all other consultants to discharge or transfer the patient to home or
another facility. Procedure revealed under physician, 1) Writes/gives order for discharge.
Procedure revealed under RN/LPN, 5) Verifies the written discharge order or obtains a telephone order for discharge from physician, if appropriate.

Patient #2 was admitted to the facility on 1/18/10 for a Right Total Knee Replacement.
Post operative physician orders dated 1/18/10 instructed to transfuse if the hemoglobin was less than 8.0. A review of the physician progress notes dated 1/19/10 revealed the patient was status post a right total knee replacement, stable, and a plan to obtain a hemoglobin and hematocrit (H&H) in the morning. The physician ordered on 1/19/10 for a H&H to be done in the morning. Lab results dated 1/20/10 revealed a hemoglobin result of 8.0. Review of physician orders did not reveal evidence of an order to discharge the patient.

The discharge summary under assessment revealed the patient was stable, the plan to check the Hemoglobin and Hematocrit in the morning and the patient was to be discharged the following day prior to being re-evaluated by orthopedics.

An interview was conducted on 11/10/10 at 2:15 p.m. with the Registered Nurse Leader
and the Director of the Orthopedic/Surgical unit. They stated the patient met all therapy goals and did not need a transfusion, and that the physician was called regarding the H+H results and agreed the patient could go home. There was no documented evidence that the physician was notified of the H&H or an order was received for discharge.

An interview and review of the record was conducted with the Risk Manager and the Manager of Clinical Standard on 11/10/10 at 1:40 p.m. They confirmed there was no written or physician telephone order for discharge or documentation that the physician was aware of the H&H results.