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Based on record review and interview, the facility failed to provide pre-discharge instruction on self-injection of medications to 4 of 11 sampled patients (#1, 12, 13, and 15) who were prescribed injectable medications as part of their post-hospital care. The findings are:

A. On 12/20/10 at 9:50 am, during interview, the Social Worker for the agency to which Patient #1 had been discharged, alleged that Patient #1 had not received instruction on injectable medications prior to her discharge from the facility.
1. Review of Patient #1's Inpatient Depart Summary dated 11/16/10 revealed a prescription for enoxaparin (commercial name: Lovenox), 40 mg/0.4mL subcutaneous solution, 40 Milligram, 0.4 Milliliter, Subcutaneous, one a day, 10 Days.
2. Review of patient #1's Discharge Summary dated 11/16/10 revealed the following statement: "The patient was sent out with prescriptions for phenobarbitol, Percocet, Oxycodone, MS Contin, Levothyroxine, iron, Lovenox, and Colace ..."
3. On 12/22/10 at 10:15 am, during interview, the Unit Director, 4 South, Surgical Specialties, stated, " Procedurally, the discharging nurse reviews the list of meds with the patient. It is the nurse's responsibility to ensure that the patient understands how to take the meds that are prescribed. In the case of Lovenox, there is Lovenox teaching in the computer in the discharge (Depart) portion. There is also an education kit that has a video and instructions. It should be documented in the EMR [electronic medical record] that Lovenox teaching has occurred. In the case of [Patient #1], there is no documentation of teaching being accomplished."
4. Review of the facility policy "Patient Education Assessment and Evaluation," revised 11/2009, revealed the following statement: "The patient education needs of our patients will be met through assessment, teaching, and evaluation. All patient education will be documented usung appropriate procedures."
5. Review of the booklet, "Competency Based Orientation, Registered Nurse, Med/Surg and SAC Units" revealed, under performance Standard II-C, "Communicates relevant patient information," the following evaluation criteria: "Documents patient/family teaching, including ..., on the Patient Teaching Record."
6. On 12/20 10 at 4:00 pm, during interview, the Supervisor, 4 South, Surgical Specialties, when questioned as to whether Patient #1 had received instructions on self-injection of Lovenox, stated, " I discharged [Patient #1]. Nursing is responsible for training her on injections. If we know that a patient will be discharged with Lovenox, Nursing would do the teaching. I did not do the teaching with her with respect to Lovenox. I did not find documentation of teaching on Lovenox."
7. On 12/22/10 at 10:50 am, during follow-up interview, The Supervisor, 4 South, Surgical Specialties, stated, "I don't remember having the drug list when I discharged [Patient #1], but I usually do. The only thing I can figure is that I missed the Lovenox because she hadn't been on it [during her inpatient stay prior to discharge]. If I had noticed the Lovenox, I would have made sure that she knew how to inject it. We document the instruction in the record."
8. On 12/21/10 at 1:30 pm, during interview, the Executive Director, Quality Outcomes, verified that Patient #1's medical record contained no documentation of training on Lovenox.

B. Review of the medical records of a sample of 10 patients who had been discharged from the facility with injectable medications revealed no documentation of education on self-injection in 3 of the 10 records reviewed (Patients # 12, 13, and 15).
1. On 12/22/10 at 4:00 pm, the Executive Director, Quality Outcomes and the Unit Director, 4 South, Surgical Specialties, verified the absence of documentation of training on self-injection of medications in the medical records of Patients #12, 13, and 15.