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Based on the investigation of complaints on May 3, 2017 which included review of 18 records, and interviews with staff, it was determined that the facility failed to ensure that Medicare beneficiaries were informed of their discharge rights.

Hospitals must inform Medicare beneficiaries who are hospitalized inpatients about their hospital discharge rights, with the Important Message from Medicare about your Rights form (IM). Of the six patient records where two IMs should have been present all six were missing the second IM. Patient # 2, an 88 year old, had one IM given on admission. Patient # 4, a 68 year old, had one IM on admission. Patient # 8, a 94 year old had no IM(s) in the record. present. Patient #7, a 104 year old, had one IM given on admission. Patient # 10, an 80 year old, had no IM(s) present in the records. Patient # 11, a 65 year old had no evidence of IM(s) in the record.

The IM are to be presented to the patient and signed within two days of admission and a second copy provided and signed no more than 2 days prior to discharge.

Based on a review of hospital policy "Interpreter Services and Other Communication Services, review of 10 open and 8 closed records, and patient and family interviews on 5/3/17, it was determined that the hospital failed to follow policy and practice related to obtaining interpreter services for patient # 2.

Review of hospital policy "Interpreter Services and Other Communication Services" (effective 4/28/16), it was stated in part, "Family members may not act as an interpreter for the patient."

A review of patient #2 records revealed that patient # 2 was an elderly Spanish-speaking patient who was admitted to the hospital in late April 2017 with symptoms of a stroke. Emergency Department documentation for triage stated in part, "Pt is Spanish speaking." Under the ED nursing assessment portion "Health Screening," nursing documentation for "Barriers to Leaning/Education" stated "Language Barrier," but then answered the form's question of "Preferred Language For Receiving Health Care Information:" as "English." There was no evidence found that the hospital obtained an interpreter in order to establish a baseline for the patient's wishes regarding having interpreter services or to determine if the patient wished the family to interpret. Patient # 2 was admitted to the hospital.

Review of the nursing admission database revealed in part, that the electronic form areas regarding patient # 2's language and need for an interpreter were left blank. Throughout patient # 2's five day admission, all communication with patient # 2 was made through the spouse or adult children. For instance, in the History & Physical done just after admission, the physician wrote, in part, "Patient is Spanish speaking and history obtained from son at baseline." A social worker note of the following day stated in part, "[Patient] understands very little English and daughter translated when SW (social worker) educated on role of CM (Case Manager)." During an interview with the surveyor during the survey on 5/3/17 using the CYRACOM interpreter phone, the patient indicated a preference for family translation. During the same interview, the patient's spouse stated that the phone had "never" been used for interpreter services.

The hospital failed to obtain interpreter services in order to establish the patient's baseline wishes with regards to interpreter services for the remainder of the admission. In addition, relying on the family for continual interpretation violated the hospital's own policy and may lead to erroneous information being exchanged between the family, patient, and staff.

Based on review of patient #1's medical record and staff interviews on 5/3/2017 it was determined the hospital staff failed to ensure the appropriate medication was ordered and administered to one patient resulting in a medication error and adverse drug event.

Patient#1 was an elderly opiate naïve patient who had been in the hospital for about 3 weeks when an order for 80 mg of methadone was administered to the patient by the patient's nurse. A code blue was called several hours later as patient went into respiratory arrest and CPR was performed. Patient required insertion of a breathing tube and was taken to the intensive care unit. As a result of the medication error, the patient suffered multiple rib fractures due to the CPR, required invasive procedures and artificial ventilation, and a prolonged hospital stay.

Interview with hospital staff revealed an error with the electronic medical system. The electronic system automatically discharged the patient after several days on observation status. This resulted in all discontinued orders having to be rewritten. The methadone order was initially ordered in error by a resident then discontinued a few minutes later before the system kicked the patient off. The discontinued methadone order was rewritten along with the other discontinued orders and administered to patient.

Based on review of patient #1's medical record and staff interviews on 5/3/2017 it was determined the pharmacy staff failed to review patient #1's 80 mg methadone order for therapeutic appropriateness resulting in a medication error and adverse drug event.

Patient#1 was an elderly opiate naïve patient who had been in the hospital for about 3 weeks when an order for 80 mg of methadone was administered to the patient by the patient's nurse. A code blue was called several hours later as patient went into respiratory arrest and CPR was performed. Patient required insertion of a breathing tube and was taken to the intensive care unit. As a result of the medication error, the patient suffered multiple rib fractures due to the CPR, required invasive procedures and artificial ventilation, and a prolonged hospital stay.

See Tag A-0405