HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure the physician wrote a discharge order prior to discharging the patient from the emergency room for 11 of 11 medical records reviewed (MR4, MR5, MR6, MR7, MR8, MR9, MR10, MR11, MR12, MR13, MR14).

Findings include:

Review on November 16, 2016, of the facility document "Medical Staff Of Barnes-Kasson County Hospital [and] Skilled Nursing Facility By-Laws Rules and Regulations," approved January 22, 2015, revealed "Preamble Recognizing that the Medical Staff is responsible for the quality of medical care in the hospital and must accept this responsibility, subject to the ultimate authority of the Hospital Governing Body, and that the best interests of the patient are protected by concerted effort, the physicians practicing in Barnes-Kasson County Critical Access Hospital and Skilled Nursing Facility hereby organize themselves in conformity with the by-laws, rules and regulations hereinafter stated. ...Barnes-Kasson County Critical Access Hospital and S.N.F. Medical Staff Rules and Regulations. ... 9. Patients shall be discharged only on written or oral order of the attending physician. The attending physician shall see that the record is complete, state his final diagnosis and sign the record within 30-days of discharge, except in those cases where outstanding reports have not yet been submitted if necessary to make a final diagnosis. ..."

Review on November 16, 2016, of the facility policy "Discharge of a Patient," last revised April 28, 2016, revealed "Subject: Discharge Of A Patient Scope: RN's, LPN's, CNA's and Unit Receptionist Purpose: See "Discharge Planning Process" Policy: Begin preparation for discharge a few days in advance of discharge date when applicable Procedure: . ...Discharge Procedure 1. Verify the Physicians Chartlink Order. ..."

Interview on November 16, 2016, at approximately 11:00 AM with EMP1 confirmed there was no discharge policy specific to the Emergency Room (ER). EMP1 confirmed staff would follow the inpatient discharge policy.

Review on November 16, 2016, of MR4 revealed the patient arrived in the ER on March 14, 2016 at 11:16 PM with the complaint of asthma attack. Documentation revealed the patient received discharge instructions at 12:25 AM on March 15, 2016. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR4.

Review on November 16, 2016, of MR5 revealed the patient arrived in the ER on March 14, 2016 at 8:36 PM with the complaint of seizure with head injury. Documentation revealed the patient received discharge instructions at 9:44 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR5.

Review on November 16, 2016, of MR6 revealed the patient arrived in the ER on March 14, 2016 at 6:50 PM with the complaints of nausea, vomiting, and leg cramps. Documentation revealed the patient received discharge instructions at 7:40 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR6.

Review on November 16, 2016, of MR7 revealed the patient arrived in the ER on March 14, 2016 at 10:00 AM with the complaint of grand mal seizure. Documentation revealed the patient received discharge instructions at 3:05 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR7.

Review on November 16, 2016, of MR8 revealed the patient arrived in the ER on March 14, 2016 at 9:00 AM with the complaint of tongue swelling and numbness. Documentation revealed the patient received discharge instructions at 12:00 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR8.

Review on November 16, 2016, of MR9 revealed the patient arrived in the ER on March 14, 2016 at 11:25 AM with the complaint of constipation. Documentation revealed the patient received discharge instructions at 1:45 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR9.

Review on November 16, 2016, of MR10 revealed the patient arrived in the ER on March 14, 2016, at 5:34 PM with the complaint of contusions to the right scapula status post fall. Documentation revealed the patient received discharge instructions at 6:46 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR10.

Review on November 16, 2016, of MR11 revealed the patient arrived in the ER on June 25, 2016, at 2:30 PM with the complaint of a syncopal episode. Documentation revealed the patient received discharge instructions at 4:50 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR11.

Review on November 16, 2016, of MR12 revealed the patient arrived in the ER on June 25, 2016, at 1:55 PM with the complaint of a swollen left eye and left ear. Documentation revealed the patient received discharge instructions at 3:00 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR12.

Review on November 16, 2016, of MR13 revealed the patient arrived in the ER on June 25, 2016, at 1:53 PM with the complaint of a laceration to the left calf. Documentation revealed the patient received discharge instructions timed at 2:30 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR13.

Review on November 16, 2016, of MR14 revealed the patient arrived in the ER on June 25, 2016, at 5:22 PM with the complaint of dental pain. Documentation revealed the patient received discharge instructions at 6:02 PM. There was no documented physician order for discharge.

Interview on November 16, 2016, with EMP1 confirmed there was no physician order for discharge in MR14.