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Based on review of the hospital policy, medical records reviewed, and staff interviews the hospital failed to provide a safe discharge plan which included training on the needed medical device for 1 of 5 (Patient #1) patients discharged from the hospital.

Review of the hospital policy "Description: Procedures for discharge planning for inpatients of [Named Hospital] last approved 05/2020", revealed "Policy ...Discharge occurs when interventions, education and the development of a appropriate discharge plan are complete."

Observation on 07/07/2021 at 0830, revealed a member of the Case Management department, the Charge Nurse and the Medical Provider discussed the discharge plans for patients. The discussion included identification of barriers to discharge and goals reached with physical therapy such as distance of ambulation.

Closed medical record review on 07/06/2021 revealed Patient #1 was a 66-year-old male admitted the the hospital on 04/05/2021 through 04/09/2021 for a complaint of left foot infection. Review of the Admission History and Physical (H & P) completed on 04/05/2021 at 2121 by the medical provider revealed the Patient #1 was alert, a good historian with a past medical history that included type 2 diabetes with peripheral neuropathy along with other medical conditions. Review of the H & P revealed the X-ray performed on 04/05/2021 revealed "gangrene (localized death and decomposition of body tissue)...Prominent soft tissue gas dorsal (back) and lateral (side) to fifth toe proximal phalanx (bone of the toe) suspicious for acute osteomyelitis (inflammation and infection of the bone or bone marrow. Deformity of the fifth metatarsal (toe) head and neck with displaced fracture of unknown chronicity...Impression/Plan:...Found to have left foot infection and probable osteomyelitis, type 2 diabetes..." Record review revealed on 04/06/2021, Patient #1 had debridement (the removal of damaged tissue from a wound) of the left foot performed by a Podiatric (medical doctor with a specialty in foot care) Surgeon. Record review revealed on 04/09/2021 at 1028, a Physical Therapist performed an evaluation of Patient #1 "...ASSESSMENT ...Pt (patient) would benefit from skilled PT (physical Therapy) intervention for strengthening and mobility training in order to improve ease of transfers and independence with gait. ...PLAN Planned Frequency of Treatment: 1 x (times) per day for: 4-5 x (times) week Planned Treatment Duration: 1 week..." Review revealed Patient #1 was discharged home on 04/09/2021 at 1700 with a rolling walker and home antibiotic infusion services.

Interview on 07/07/2021 at 1220 with the Podiatric Surgeon who performed the surgery on 04/06/2021 for Patient #1 revealed he reviewed the notes of the Physical Therapist evaluation performed on 04/09/2021 related to the recommendations. Interview revealed the surgeon felt Patient #1 could have physical therapy at an outpatient level if needed. Interview revealed, "I did not have any conversation with (Named Physical Therapist) related to Patient #1. Usually the therapist would let us know if there was a glitch to home discharge plan. In my view for the discharge of 04/09/2021, Patient #1 did not need home physical therapy ordered."

Interview on 07/07/2021 at 1335 with Case Manager (CM), revealed "Physical therapy was not part of the Interdisciplinary Discharge Team (IDT) meeting and therefore was not informed of the planned discharge for Patient #1."

Interview on 07/07/2021 at 1415 with Physical Therapist (PT) who performed the evaluation on 04/09/2021 for Patient #1 revealed the PT was not aware of the planned discharge on 04/09/2021 for Patient #1. Interview revealed PT did not participate in the IDT (Interdisciplinary Team) meeting at 0830 and was not informed of the intention of Patient #1 to discharge home on 04/09/2021. Interview revealed PT had intended to see this patient again after 04/09/2021 inital assessment. Interveiw revealed the PT had not completed the training on the use of the walker intended for the aid of ambulation and the walker height was not confirmed as accurate hieght to use for Patient #1.

Telephone interview on 07/08/2021 at 0800, with the Customer Service Representative for the company assigned as the supplier for the medical equipment (walker) revealed there was no documented evidence of the walker delivered to the patient's room on 04/09/2021 was confirmed for height and comfort.

NC0017269