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A. Based on medical record review, patient interview, and staff interview, it was determined in 3 of 3 (Pts #1, #3, #5) medical records reviewed, in which the patient developed postoperative infection which required readmission with repeat surgical intervention, the Hospital failed to ensure patients were instructed in discharge care of surgical incisions.

Findings include:

1. The medical records of Pt #1 were reviewed. Pt #1 was admitted to the Hospital on 5/8/12 with the diagnosis of Osteoarthritis, underwent elective total hip replacement, and was discharged on 5/10/12 with a dressing to the incision. There were no discharge orders and/or instructions related to the care of the incision. Pt #1 was readmitted on 6/1/12 with the diagnosis of Peri-prosthetic infection of the Right Hip, underwent I&D of the wound on 6/3/12 with placement of VAC dressing, underwent I&D with secondary closure of wound on 6/9/12, and was discharged home with a PICC and was to receive 6 weeks of IV antibiotics.

2. On 8/8/12 at 11:25 AM, a telephone interview was conducted with Pt #1 to evaluate discharge instructions related to wound/ incision care. It was verbalized by Pt #1 that no instructions related to the care of the incision, signs and symptoms to report, whether the dressing needed to be changed and/or how often, or any precautions to take (such as no baths) were given. Pt #1 did have gauze squares and alcohol swabs that were brought home with Pt #1. Pt #1 retrieved the hospital discharge instructions and information that was sent home with Pt #1 and verified that none of this information was in the packet.

3. The medical records of Pt #3 and Pt #5 were reviewed. Both were admitted for orthopedic surgical intervention, were discharged to their respective residence, developed postoperative infections and required readmissions for further surgical intervention within 3 to 4 weeks. Both initial admissions failed to include discharge orders and/or instructions for care of the incision.

4. During a staff interview, conducted with the Quality Coordinator on 8/7/12 at 3:00 PM , it was verbalized that the expectation is that dressing and/or wound care should be ordered by the physician upon discharge and that dressing and/or wound care instructions are to be put on the patients' discharge instructions along with the signs and symptoms to report and any precautions to be taken.

5. During a staff interview, conducted with the Infection Control Nurse on 8/7/12 at 3:45 PM, it was confirmed that physician discharge orders, as well as patient discharge instructions, should include dressing and/or wound care, signs and symptoms to report, and any precautions to be taken.