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Based on interview and document review, the facility failed to provide safe discharge planning for 1 of 10 patients (P2) when P2 was discharged to a community drop-in facility on 8/30/24 which was closed for the night and would not reopen until Monday 9/2/24 at 8:00 a.m. In addition, the facility did not ensure P2 had appropriate medication available.

As a result, the hospital was found out of compliance with the Condition of Participation Discharge Planning at §482.43

findings Include:

A condition level deficiency was issued. See A0813.

Based on interview and document review, the facility failed to provide safe discharge planning for 1 of 10 patients (P2) when P2 was discharged to a community drop-in facility on 8/30/24 which was closed for the night and would not reopen until Monday 9/2/24 at 8:00 a.m. In addition, the facility did not ensure P2 had appropriate medication available.

Findings include:

P2's Provider Note dated 8/27/24 at 9:24 p.m., indicated P2 was assessed with no medical concerns or acute needs. P2's diagnosis was adverse effect of methamphetamines.

P2's Behavioral Health Telehealth Diagnostic Assessment dated 8/27/24 at 9:21 p.m., indicated P2 was brought to the emergency department (ED) via law enforcement with a revocation court order of his mental illness/civil commitment. P2's decision maker was his legal guardian. P2's preferred pharmacy was in Brainerd, MN. P2 was not agreeable with follow-up recommendations including detox referral or direct chemical dependency (CD) treatment. P2 was under a court order to immediately apprehend and return to a treatment facility. However, P2 was unable to return to his intensive residential treatment services (IRTS) facility because they refused to take him back. The hospital did not complete a safety plan for P2 because he was not at high risk for harm to himself or others, and was under a court order for CD treatment. "[P2] continues to be at risk with no safe discharge plan from a chemical dependency standpoint." P2 would not engage in a safety planning conversation.

P2's Pharmacist Note dated 8/28/24 at 8:55 a.m., indicated P2's medications included Cogentin (a medication used to treat involuntary movements due to the side effects of antipsychotic medications) take 1 milligram (mg) 2 times a day and Risperdal (an antipsychotic medication used to treat schizophrenia and bipolar disorder) take 3 mg 2 times a day.

P2's Care Management Note dated 8/29/24 at 8:39 p.m., indicated a complete chemical dependency assessment was scheduled with an inpatient program on 9/4/24. The note also indicated the facility did not have a reason to hold P2 in the hospital, so P2 would be sent to a community drop-in facility in Brainerd, MN (approximately 220 miles away) via secure transportation. The hospital was aware P2 would not have access to the day program until daytime hours on 8/30/24. The Adult Services Supervisor for that county did not support discharging P2 to homelessness.

P2's After Visit Summary dated 8/30/24 7:43 a.m., indicated P2's preferred pharmacy was located in Austin, MN.

P2's Emergency Department nurse manager note dated 8/30/24 at 6:19 p.m. indicated P2 was not accepted to a crisis center and a detox facility due to high acuity. P2 was placed on a wait list for admission to a community behavioral health hospital with an unknown timeframe until a bed would be available. No additional options for placement were identified. P2 had requested to be discharged to a community drop-in facility in Brainerd. An attempt was made to contact the drop-in facility, but no one was available. P2 was provided a safe ride and was dropped off in Brainerd.

A Minnesota court records online case search on 10/3/24, indicated a request to revoke provisional discharge and an order to apprehend and hold was filed on 8/27/24.

On 10/2/24 at 2:56 p.m., P2's legal guardian (G)-A stated P2 could not make his own medical decisions and was on a legal commitment. G-A received an email from the hospital at the end of the day on 8/30/24 stating P2 would be discharged after hours to a community drop-in facility in Brained. G-A stated law enforcement picked P2 up from a homeless encampment in Brainerd sometime during the early hours of 8/31/24, and brought him to a hospital behavior health unit approximately 120 miles away.

On 10/3/24 at 8:19 a.m., a representative from the community drop-in facility in Brainerd stated their facility was a day drop-in facility, and open Monday through Friday 8:00 a.m. through 5:00 p.m. The facility did not not provide an overnight place to sleep. There was no one at the facility during closed hours.

On 10/3/24 at 1:21 p.m., registered nurse (RN)-A stated there was no indication in P2's medical chart if medications or prescriptions for medications were sent with P2 at time of discharge. P2 was not admitted to the hospital, was only seen in the ED, so ED staff would have reviewed the medication list but would not have verified if P2 had the medication with him. P2 was discharged via secure transportation which meant the transport company would only drop off P2 at the address provided by the facility.

On 10/3/24 at 1:24 p.m., social worker (SW)-A stated the hospital would not have sent a formal referral to a shelter, but could not say if the community drop-in facility was a shelter or not. The hospital expected P2 to spend the night at the community drop-in facility.

On 10/3/24 at 4:12 p.m. a representative from the transport company used to transport P2 confirmed P2 was dropped off outside the community drop-in facility in Brainerd at 1:06 a.m. on 8/31/24.

The facility Discharge Planning procedure dated 2/23/23 directed the bedside nurse to verify discharge documentation for accuracy to include medication list and prescriptions. Care management was instructed to continue to follow and assess for ongoing care changes, and update the discharge plan as needed. The discharging provider was instructed to complete necessary prescriptions. The multidisciplinary team was instructed to arrange or assist in arranging services required by the patient after discharge in order to meet their ongoing needs for care and services.