HospitalInspections.org

Based on record review and staff interviews, the hospital failed to adequately identify post-hospital services needed through discharge planning for 1 (#1) of 10 discharged medical records. Findings include:

Patient #1 was transferred from a hospital and admitted to the hospital on 12/23/10; diagnoses included aortic stenosis, bipolar disorder with schizophrenia, chronic obstructive pulmonary disease, hepatitis C, type 2 diabetes, hypothyroidism, degenerative joint disease, chronic steroids, and renal insufficiency.

Review of the Discharge Planning Policy and Procedure documented the following:
--"At the time of discharge, services to occur post discharge will be written on the patient's discharge summary;
--"...Charting will reflect involvement by the patient, family or explanation/reason the patient did not participate. It will also include choices made re: medical equipment, vendors, nursing facilities and home health agencies."

On 3/8/11 at 3:20 p.m., during an interview with the social worker, she stated the daughter was willing to care for patient #1. The daughter lived out of town. Staff member A, a social worker, arranged the ambulance transfer for patient #1 and contacted a medical equipment supplier. The medical equipment supplier did not return the phone call to arrange services prior to patient #1's discharge. Staff member A stated she did not make any arrangement for medications, psychological services or oxygen prior to the patient's discharge.

On 3/8/10 at 4:24 p.m., an Adult Protective Service Worker stated in a telephone interview that when patient #1 arrived at her daughter 's apartment on 1/14/11, there was no medical equipment, no medications, and no oxygen. Due to not having the medical equipment, oxygen and medications in order to care for her mom, the daughter called an ambulance on the same day of discharge. Patient #1 was admitted to one of the hospitals in Missoula.

Review of the discharge planning lacked documentation to address medications, psychological needs, oxygen, and confirmation to supply medical equipment prior to discharging patient #1.

Based on record review and staff interviews, the hospital failed to evaluate the availability of post-hospital services for 1 (#1) of 10 sampled discharged records. Findings include:

Patient #1 was admitted to the hospital on 12/23/10; diagnoses included aortic stenosis, bipolar disorder with schizophrenia, chronic obstructive pulmonary disease, hepatitis C, type 2 diabetes, hypothyroidism, degenerative joint disease, chronic steroids, and renal insufficiency.

On 3/8/11 at 1:00 p.m., the medical record was reviewed. The medical record documented that the patient had psychological requirements, was on 3 liters of continuous oxygen, and was non-ambulatory. The discharge plan lacked documentation by the nurse and social worker of an evaluation for post-hospital needs and availability of services for medications, oxygen, medical equipment and psychological treatment prior to discharging patient #1.


Review of the Discharge Planning Policy and Procedure documented the following under Procedure:
-- "At the time of discharge, services to occur post discharge will be written on the patient's discharge summary;
-- "...Charting will reflect involvement by the patient, family or explanation/reason the patient did not participate. It will also include choices made re: medical equipment, vendors, nursing facilities and home health agencies."

On 3/8/11 at 3:20 p.m., during an interview with staff member A, a social worker, she stated the daughter was willing to care for patient #1. Staff member A knew the daughter lived out of town in an apartment and would need medical equipment in order to care for her mother. Staff member A acknowledged that she did contact a medical equipment supplier for a lift and commode. She stated that the medical equipment supplier did not call her back to confirm that the needed medical equipment would be delivered prior to patient #1's arrival at the apartment. Further, staff member A stated she was not asked to set up a discharge plan to address patient #1's medications, psychological needs, or oxygen. "I did not have anything to do with the meds or oxygen."

On 3/8/11 at 11:15 a.m., during an interview with staff member B, the director of nursing, the surveyor was informed that the procedure was for nursing staff to work in conjunction with the social worker to identify the discharge planning needs of patient. The Director of Nursing stated that she was not aware if the nurse on duty set up services for the medications, psychological services, or oxygen prior to patient #1's discharge.

On 3/8/10 at 4:24 p.m., an Adult Protective Service Worker was interviewed by telephone. She stated when patient #1 arrived at her daughter ' s apartment, there was no medical equipment, no medications, and no oxygen. Due to not having the medical equipment, oxygen, and medications to care for her mom, the daughter called an ambulance on the same day of discharge. Patient #1 was admitted to a local hospital in Missoula.

Based on record review and staff interviews, the hospital failed to arrange post-hospital services for 1 (#1) of 10 sampled discharged medical records. Findings include:

Patient #1 transferred from another hospital to the hospital on 12/23/10; diagnoses included aortic stenosis, bipolar disorder with schizophrenia, chronic obstructive pulmonary disease, hepatitis C, type 2 diabetes, hypothyroidism, degenerative joint disease, chronic steroids, and renal insufficiency.

During the review of patient #1's medical record, the surveyor noted the had psychological requirements, the patient was on 3 liters of continuous oxygen, the patient was non-ambulatory.

The discharge plan lacked documentation that the hospital coordinated services regarding medications, oxygen, medical equipment, and psychological services prior to patient #1's discharge on 1/14/11 at 2:00 p.m. The discharge plan lacked documentation that the daughter was educated, trained or advised on the post-hospital services needed after patient #1 was discharge.

A social service note on 1/14/11 at 12:07 p.m., documented that the medical equipment company "will call me back if arrangements can be made." Staff member A, a social worker, stated, "I do not know why the medications were not set up. I was not contacted. The oxygen was missed by everyone." Staff member A acknowledged that patient #1 was discharged "without medications, medical equipment, psychological services, and oxygen. "

On 3/8/10 at 4:24 p.m., an Adult Protective Service Worker stated in a telephone interview that when patient #1 arrived at her daughter's apartment, there was no medical equipment, no medications, and no oxygen. Due to not having the necessary equipment, oxygen, and medications, the daughter had to call an ambulance and the patient was admitted to a hospital in Missoula. The patient passed away on 2/25/11.

The discharge plan lacked documentation of an evaluation for post-hospital needs and the availability of services by the nurse and social worker for medications, oxygen, medical equipment prior to discharging patient #1.