HospitalInspections.org

Based on record review, interview and review of facility policy, the facility failed to reassess discharge plans for 1 of 7 sampled patient records reviewed for appropriate and safe discharge plans (#1).


Findings:

Review of hospital policy "Patient Discharge" read, "To assure timely discharge of patients, the charge nurse is responsible to monitor the progress of the discharge process until the patient has been discharged from the room...."

Patient #1 was admitted to the hospital's intensive care unit on 9/29/15. The record documented the patient was discharged to her home on 10/17/15 with a peripherally inserted central catheter (PICC) line. The patient had a history of drug abuse.

A case management note dated 10/15/15 read, "Spoke to (name of family member), she agrees with (name of SNF), will wait for available bed tomorrow or Saturday per (name of facility representative). A case management note dated 10/16/15 read, "no d/c today...."

A physician order dated 10/17/15 to discharged the patient from the hospital.

A Discharge Instruction form dated 10/17/15 revealed a destination of "Home." Page 2 of the Discharge instructions revealed a handwritten additional note which read, "I will not use the PICC line to use...." An illegible signature was written next to the entry.

Documentation in the medical record revealed the following case management notes:
10/18/15 Late entry for 10/17/15 - "Received an unconditional discharge order. Pt had evidently asked to be discharged home. Pt. had been scheduled to go to (SNF). I did not receive a call or inquiry from nursing or physician. Pt was discharged home with her aunt at her request....I received a call from pt's. aunt inquiring about pt's. (patient's) PICC line which pt. was discharged home with it in place. She was asking if pt. was to receive IVAB (intravenous antibiotics)." Further documentation related the case manager contacted the patient's nurse to inquire of the patient's discharged medications and no intravenous medications were written for the patient. No IVAB ordered. Requested the nurse to call the patient 10/17/15 at 6 PM."
10/18/15 AT 2:55 PM, "Contacted the director of the 3rd floor to assist in patient's return to the hospital from home."

Patient # 1 was readmitted to the hospital on 10/19/15 and again discharged on 10/22/15 to an area skilled nursing facility (SNF) with the PICC line for IVAB administration.

On 11/16/15 at 2:40 PM, the third floor charge nurse revealed the on-call physician came in and wrote an "unconditional discharge for the patient and she went home with her PICC line. He related the patient's nurse was an agency nurse and it was her first time on the floor. He related the nurse filled out and went over the patient's discharge instructions with the patient."

On 11/16/15 at 3:10 PM, the director of case management related there were 4 or 5 case mangers in the hospital over the 10/17/15 weekend. However, they respond to physician orders and do not routinely check on current patients unless they get a call. She related patient #1's discharge plan was for the patient to be transferred to a SNF for continued IVAB and not to be discharged home."

At 12:05 PM on 11/16/15, the risk manager specialist revealed she had received a telephone call from the patient's mother on 10/21/15 due to her concern that the hospital sent the patient home with a PICC line and she had a history of drug abuse. The risk management specialist documented the complaint and the facility investigated the incident.

On 11/16/15 at 5:05 PM, the risk manager and the vice president of quality revealed the facility had investigated the incident, had returned the patient to the hospital and then discharged the patient to a SNF.