HospitalInspections.org

Based on staff interviews, review of one (1) of three (3) medical records (#1), and review of facility policy and procedure, it was determined the facility failed to ensure that: 1) the patient's discharge plan is discussed with the patient and family; 2) the discharge instructions specify the post-hospital plan; 3) staff follow up with the patient to ensure implementation of the discharge plan.

Findings include:

Reference: Facility policy titled, "Discharge Planning and the Continuum of Care" states, "... Procedure... Documentation of discussion and patient/family agreement with plan... They will also receive discharge instructions that specify the post-hospital plan... The Social Worker/care manager is responsible for follow-up to ensure the implementation of the discharge plan."

Review of medical record #1 revealed the following:

1) The patient was admitted to the hospital on 2/14/22. There was no evidence that the discharge plan was discussed with the patient and family and that they were in agreement with the plan. Staff #1 and Staff #2 confirmed this finding on 4/19/22.

2) The patient was discharged on 2/18/22. The patient's discharge instructions did not specify the post-hospital plan. Staff #1 and Staff #2 confirmed this finding on 4/19/22.

3) There was no evidence of follow-up by the social worker or case manager to ensure implementation of the patient's discharge plan. Staff #1 and Staff #2 confirmed this finding on 4/19/22.