HospitalInspections.org

Based on interview and document review, the hospital failed to reassess a discharge plan for 1 of 10 patients (P1)reviewed when the patient's family member expressed concern that the patient would be unable to take care of himself alone at home. Despite these concerns, hospital staff discharged the patient and the patient was readmitted to the hospital 3 days later.

Findings include:

P1's medical record review revealed P1 's admission to the hospital occurred on 12/19/18, with discharge on 12/21/18.

P1's hospital discharge summary dated 12/21/18, revealed P1's diagnoses included hypovolemic shock, dehydration, gastroenteritis, and hematoma of lower left extremity. P1's history included right below the knee amputation. P1's hematoma had opened up, and started draining fluid during the hospital stay.

A review of P1's discharge instructions dated 12/21/18, revealed P1 had a small pin sized open area with scant drainage, but no instructions for care of the draining wound.

A review of a social worker note dated 12/21/18, revealed P1's daughter expressed concern related to P1's ability to take care of himself alone back in his own home. The social worker documented that she called physical therapy (PT) and occupational therapy (OT) to come to assess P1's safety for discharge, but the patient was discharged before that assessment could take place.

P1's medical record revealed P1 was readmitted to the hospital 12/24/18, and discharged on 12/27/18, with discharge plans including daily wound care, and PT and OT.

During an interview on 6/25/19, at 7:15 a.m. registered nurse (RN)-D, the RN who discharged P1 on 12/21/18, stated she was never told by the social worker that P1 was supposed to have a safety assessment from PT and OT before discharge. If she had been told, she would have delayed the discharge.

During an interview with P1's community health nurse on 6/25/19, at 8:10 a.m. she stated P1 was inappropriately discharged home on 12/21/18. The patient had no wound care instructions, and had no one available to care for him. The patient's family was very concerned about the patient being home alone and his safety.

During an interview on 6/25/19, at 11:10 a.m. RN-E (care coordinator) stated P1 had home care set up on 12/21/18, prior to discharge. RN-E stated in her experience, sometimes it takes home care 5 to 7 days to get out to see a patient after discharge. P1's daughter expressed concern related to P1 going home alone prior to discharge. There were no wound care orders for P1 on his discharge instructions.

A review of the complaint dated 12/26/18, revealed the patient's family was never notified of the plan for PT or OT safety assessment of the patient before discharge. If they had been notified, they would not have taken the patient home in 12/21/18.
The document titled Interdisciplinary Discharge Planning dated reviewed 3/18, directed under Purpose: The interdisciplinary Discharge Plan is conclusive of three major objectives:
1. The patient is informed in a timely manner of planning for discharge or transfer to another organization or level of care.
2. The patient will be discharged to a safe environment where continued care needs will be met once the patient has met all their treatment objectives and maximized their hospital or swing bed potential.
3. The physician or associate provider, health care team, patient, and family are involved in the formulation of the discharge plan.

Under the section titled: Patient Admission Process:
C. Patients needing support services post-discharge will be identified by any discipline who works with the discharge planning team and a referral will be sent to the appropriate agency or support service.
E. The primary caregiver (provider, nurse, social worker) will act as a liaison for all disciplines and patient/family in communication of the discharge plan.