HospitalInspections.org

Based on interviews and document review, the facility failed to ensure a patient was discharged with the necessary durable medical equipment (DME) for 1 of 2 patients discharged who required DME (Patient #2).

Findings include:

Policy:

According to the policy, Discharge Planning, the facility utilizes an interdisciplinary approach to discharge planning which begins on admission. Evaluation of needs is performed on admission and throughout hospitalization so that post hospital care needs are identified before discharge.

Ongoing discharge planning is conducted throughout the patient's course of care. Patients are screened to determine post discharge needs, especially those determined to be at risk of adverse health consequences post-discharge if they lack discharge planning.

1. The facility failed to ensure Patient #2 was discharged with a walker for ambulation.

a. Review of Patient #2's medical record revealed she was admitted on 4/17/18. According to Physician #1's discharge note, dated 4/20/18, Patient #2 was admitted after sustaining a fall at a local shelter. While in the emergency department, she was diagnosed with dehydration and an acute kidney injury. Physician #1 admitted Patient #2 to inpatient and completed her admission orders, which included a consultation with PT and OT.

While in the emergency department, a social worker (Case Manager #10) evaluated the patient for potential discharge needs. In her notes, dated 4/17/18 at 5:38 p.m., she documented Patient #2 had been asked to leave her sister's home three days prior to the admission. She also documented the patient had left her mobility scooter at her sister's home.

b. According to Patient #2's medical record, on 4/18/18, at 11:40 a.m., a physical therapist (PT #4) saw the patient for an evaluation and treatment session. In her notes, PT #4 documented the patient used a mobility scooter and front wheel walker at home as assistive devices. She also documented Patient #2 completed all transfers in and out of bed, and all walking during the session with the aid of a front wheel walker.

According to Patient #2's medical record, on 4/19/18 at 11:25 a.m., PT #3 saw Patient #2 for a treatment session. He documented Patient #2 exhibited "a slowed step to gait in front wheel walker with right lower extremity leading while ambulating." During the treatment session, Therapist #3 documented the patient would need a front wheel walker or a four wheel walker upon discharge.

c. On 4/18/18 at 2:57 p.m., Case Manager #5 documented Patient #2 would likely discharge directly to a homeless shelter. She also documented Patient #2 may need a walker, as well as transportation and medication vouchers at discharge.

d. On 4/20/18 at 12:23 p.m., Case Manager #5 documented Patient #2 was being discharged on 4/20/18 via taxi. She documented Patient #2 would be taken to a local homeless. On 4/20/18 at 1:52 p.m., Case Manager #5 documented she had spoken with an employee at the shelter. According to her note, Patient #2 told the shelter employee she was unable to walk when she arrived at the shelter. Case Manager #5 documented she informed the shelter employee Patient #2 had a walker, however, it was stored at her family's home and Patient #2 had refused to contact her family regarding the walker.

e. An interview was conducted with an occupational therapist (OT #6) on 8/8/18 at 11:59 a.m. During the interview, she stated the "step to gait" walking as documented by PT #3 on 4/19/18 indicated the patient likely relied on a walker for support. OT #6 stated she would not have discharged Patient #2 without a walker, as it would be a "huge fall risk."

f. An interview was conducted with PT #8 on 8/8/18 at 11:38 a.m. PT #8 stated based on therapist documentation, Patient #2 would have required a walker to ambulate. He stated therapists typically would have patients try walking without a walker prior to discharge in order to assess their abilities. However, he stated the therapists did not attempt this with Patient #2 because she used a walker at her baseline walking ability. Therefore, he could not establish or determine her ability to walk without a walker.

g. An interview was conducted with Case Manager (CM) #7 on 8/8/18 at 11:00 a.m. CM #7 stated she did not see any indication Patient #2 was discharged with a walker. She stated if a patient was unable to access their walker due to family issues or location of the walker, the case manager should have arranged for another walker to ensure a safe discharge.

h. An interview was conducted with the care management manager (Manager #9) on 8/8/18 at 1:15 p.m. Manager #9 stated, "I do not see where she received a walker, or that she was sent home with one."