HospitalInspections.org

Based on review of hospital policies/procedures, medical records, and interviews, it was determined the hospital failed to demonstrate that 5 of 7 discharged patients selected his/her home health agency (HHA) or skilled nursing facility (SNF) from a list of qualified aftercare providers (Patients #2, 3, 5, 6 and 7), as evidenced by:

1. failure to document discharge planning that included a list of HHAs provided to Patients #2, 6 and 7; and

2. failure to document discharge planning that included a list of SNFs provided to Patients #3 and 5.

Findings include:

1. The hospital policy titled Discharge #5020 (last revised 01/10), requires: "...If the attending physician has ordered discharge planning for home health care the RN/LPN will inform the patient of the pending discharge and discuss what HHA (home health agency) the patient would prefer...."

Case Manager RN #4 indicated that she provides a list of Medicare Certified Home Health Agencies (14 listed) and contact information to applicable patients for their consideration and selection, during interviews conducted on 07/24/12 and 07/25/12. She stated that she also refers to her notebook of resources, and online information and listings, however she did not have a current online list for review.

Patient #2 was admitted on 07/12/12 and discharged on 07/15/12, according to the medical record. The physician ordered HHA services. The Multidisciplinary Planning document revealed, "...Contracted Provider for Home Health (provider #6)...." There was no documentation to verify that the patient was provided a list of HHAs from which to select.

Patient #6 was admitted on 07/12/12 and discharged on 07/12/12, according to the medical record. The physician ordered HHA services. The Multidisciplinary Planning document revealed: "...Contracted Provider for Home Health (provider #15)...selected from in-network list...." The list provided by Case Manager RN #4 did not include provider #15.

Case Manager RN #4 provided a pre-printed list of 14 HHA companies that she provides to patients, during the interview conducted on 07/25/12. The list however, did not include HHA provider #15. Case Manager RN #4 indicated that her source for provider #15 was in the resource manual, however was unable to provide evidence of the reference material at the time of the interview.

There was no documentation to verify that the patient was provided a list of HHAs.

Patient #7 was admitted on 07/23/12 according to the medical record. The physician ordered HHA services. The Multidisciplinary Planning document (reviewed on 07/25/10 at 0945) revealed: "...Contracted Provider for Home Health (provider #13)...pt. (patient) choice from list...." The patient stated, during an interview conducted on 07/25/12 at 0930, that she had not yet met with the Case Manager regarding discharge planning; that the hospital did not provide a list of HHAs; and "...the doctor picked out the home health agency...." Patient #7 verified that no other HHAs were discussed or presented for selection.

The Chief Nursing Officer (CNO) confirmed that the hospital did not have documentation confirming that Patients #2, 6 and 7, were provided lists from which to select HHAs.

2. The hospital policy titled Transfer of Patient to Another Facility #5008 (last reviewed 02/11), requires: "...The referral is planned with the patient, his/her family, and the healthcare team...."

Case Manager RN #4 indicated that the hospital provides two (2) booklets to patients discharged to SNFs that contain lists of SNFs for patient selection, titled "Spotlight Senior Services Living Options," and "Senior Directory."

Patient #3 was admitted on 07/13/12 and discharged to a SNF (per physician's order) on 07/15/12, according to the medical record. The Multidisciplinary Discharge Planning document revealed, "...pt. request to go to (SNF #1)...." There was no documentation to verify that the patient was provided the booklets from which to select.

Patient #5 was admitted on 07/16/12 and discharged to a SNF (per physician's order) on 07/19/12, according to the medical record. The Multidisciplinary Discharge Planning document revealed, "...Skilled Nursing Facility...(SNF #1)...pt. choice from list...." There was no documentation to verify that the patient was provided the booklets from which to select.

Case Manager RN #4 and the CNO both confirmed during interviews conducted on 07/24/12 and 07/25/12, that the hospital does not document the source from which patients make their selection.

Based on review of hospital policies/procedures, medical records, and interviews, it was determined that the hospital did not require documentation in the medical record that 5 of 7 patients were provided lists of SNFs and HHAs in consideration for selecting their aftercare provider (Patients #2, 3, 4, 5 and 7).

Findings include:

The hospital policy titled Discharge #5020 (last revised 01/10), requires: "...If the attending physician has ordered discharge planning for home health care, the RN/LPN will inform the patient of the pending discharge and discuss what HHA (home health agency) the patient would prefer...."

The hospital policy titled Transfer of Patient to Another Facility #5008 (last reviewed 02/11), requires: "...The referral is planned with the patient, his/her family, and the healthcare team...."

Medical records for Patients #2, 3, 5, 6 and 7 discharged to SNFs or HHAs did not include documentation to verify that the hospital provided lists for which to assist the patients in selecting their aftercare providers.

Reference tag A 0823 #s 1 and 2.

The CNO confirmed that hospital policies did not identify the process requiring documentation that applicable patients are provided lists of SNFs and HHAs, during an interview conducted on 07/25/12.