HospitalInspections.org

Based on observation, interview and patient medical record reviews, the hospital did not identify at risk patients for discharge and provide adequate education and planning on their medication regimes; for 2 of 10 patients (#3 and #6).

Findings Include:

1. Patient #3, was admitted to the facility on 6/7/11 and discharged to home on 6/10/11. The discharge orders and summary state discharge medications to be: Klonopin 0.5mg po (oral)TID (three times day) prn ; Effexor 75mg po every day; Paxil 20mg po every day. On the discharge order " yes " is checked for prescription written. The physician discharge summary dictated on 6/11/11 and transcribed on 6/12/11, remains unsigned by the physician states: Dilantin 100mg po QID (four times per day), Cardura 4mg po HS (bedtime/hour of sleep), Paxil 20mg po daily, Effexor XR 75mg po daily, Motrin prn, Klonopin 0.5mg po q6 hours prn (every 6 hours as needed). The admission orders " Medication Reconciliation " state to continue the following during admission but does not give direction for " continue at discharge " .
2. Interview was conducted of the discharge coordinator/ Director of Case Management on 7/19/11, at 11:00 am regarding the discharge planning process. The Director of Case Management, LCSW, explained that every week potential discharges are discussed in an interdisciplinary meeting. Patients who stay less than one week, are not discussed at the weekly meeting. Each discipline evaluates but the comprehensive meeting process does not discuss that patient. When asked when case managers are present to coordinate discharge planning, she responded that the social workers are there Monday through 8:30am-Friday 8:30-5:00pm and on Saturday/Sunday 7a-7p. Any off-hours discharges, the nurses must handle it. When asked about the reconciliation of the medications given in house and the continue at home medications, she stated that the nurses are in charge of that.
Interview of the Assistant Director of Nursing, assigned to coordinate components of discharge planning, was conducted on 7/19/11, at 1:10pm. She stated that social services have the main responsibility for discharge planning follow through. After hours the nurses must pick up that responsibility. When asked about reviewing the prescriptions and patient education prior to discharge she stated that the nurses do that. The lack of medication reconciliation for patients numbers #3 and
#6 were discussed and no additional information was available. She stated we have several places in the medical record for lists of home medications, inhouse medications, and new order medications which are to be taken after discharge. We are trying to simplify the process. When asked about physician orders for medications which may be confusing to the patient or may not be filled by the pharmacist; she was not aware of this. The order for Klonopin 0.5mg, TID prn, does not match reconciliation, physician discharge summary and is not a complete order to explain the PRN usage. She agreed that this could confuse the patient as to when to take the medication. The nurse would normally be responsible for reviewing this, she stated.
3. Patient #6, was admitted on 11/15/10 and discharged home on 12/3/10. Review of medications for discharge orders state: Lexapro10mg oral daily; Klonopin 0.5mg daily as needed; Prilosec 20mg oral daily; Multivitamin with minerals one daily; Clonidine 0.1mg oral every 6 hours. Review of the medical record Discharge Orders and Summary had incomplete components for " medications reconciled at discharge/patient was given opportunity to have questions and concerns addressed " . No additional information offered by Case Manager or Assistant Director of Nursing