HospitalInspections.org

Based on record review and interview the facility failed to provide accurate and detailed discharge instructions per policy to 8 of 10 patients reviewed (Pts. #1, 2, 4, 5, 6, 8, 9, 10).

Findings:

Facility policy "Discharge of Patient" dated 10/2014 states in part: "5. The RN will order all medications needed from the appropriate pharmacy and make any return appointments necessary for the patient."

Per the facility's "Online Medication Reconciliation" instructions, under "Completing Discharge Med Reconciliation" the instructions state in part: "3. ii) If the patient began a new med in the hospital and will be on it at home, select Create New Rx. iii) If home medications will continue...select Continue" These instructions were reviewed on 12/16/2014 at 2:35 PM.

1) Per Pt. #1's MR, reviewed on 12/16/2014 at 11:35 AM, Pt. #1 was discharged from the facility on 10/19/2014 with a new medication order for Bactrim (antibiotic). Discharge instructions to the patient did not include Bactrim on the medication list. Pt. #1's discharge medication list was verified with Staff D at the time of the review. Staff D stated that Bactrim "should have been on the list."

Pt. #1's discharge instructions include a follow up appointment with MD A with the following comments: "Nursing to Schedule appointment with [MD A]..."

Per interview with Staff D on 12/16/2014 at 2:45 PM, Staff D stated that the nursing staff does not "usually" schedule patient follow up appointments. "Most all" follow up appointments are made by the patients. Per Staff D, in the event that the facility is scheduling a follow up appointment on behalf of the patient, the nursing staff leaves a message for the scheduler, the scheduler makes the appointment for the patient and then calls the patient.

During an interview with Staff F on 12/16/2014 at 2:55 PM, Staff F stated, "when I schedule [a patient follow-up appointment] I call the patient and let them know." Staff F stated that MD A comes to the facility once weekly to see patients, but "I don't schedule" patient appointments with MD A. Staff C, D and F were unable to state how patient follow up appointments are made with MD A if the assigned scheduler does not schedule it.

2) Pt. #2's MR, reviewed on 12/16/2014 at 11:55 AM, contained a new order for cephalexin (antibiotic) during the patient's hospitalization from 10/18/2014 to 10/21/2014. The patient's discharge instructions list cephalexin under the "Continued Home Meds" list. There is no documentation regarding where the patient is to obtain the medication upon discharge. Pt. #2's discharge instructions for a follow up appointment on 11/4/2014 do not state if the appointment was made by the nursing staff or if the patient was responsible for scheduling the appointment.

3) Pt. #4's MR, reviewed on 12/16/2014 at 12:25 PM, contained dosage changes for 2 home medications--metoprolol and levothyroxine (thyroid medication)--upon discharge on 11/4/2014. The patient's discharge instructions lists these medications under the "Continued Home Meds" list. Pt. #4's discharge instructions for a follow up appointment on 11/11/2014 do not state if the appointment was made by the nursing staff or if the patient was responsible for scheduling the appointment.

4) Per Pt. #5's MR, reviewed on 12/16/2014 at 12:35 PM, Pt. #5 was discharged from the facility on 11/9/2014 with a new medication order for Bactrim. The patient's discharge instructions list Bactrim under the "Continued Home Meds" list and there are no instructions as to where the patient is to obtain the medication upon discharge.

5) Pt. #6's MR, reviewed on 12/16/2014 at 12:40 PM, contained a new order for levofloxacin (antibiotic) upon discharge on 11/10/2014. The patient's discharge instructions state "pick up your new meds at [Pharmacy]", however, the new order is listed under "Continued Home Meds" and does not state which medication is a new prescription.

6) Pt. #8's MR, reviewed on 12/16/2014 at 12:55 PM, contained a new order for levofloxacin (antibiotic) upon discharge on 11/21/2014 for an "additional 7 days." The new medication is listed in the patient's discharge instructions as "Continued Home Meds" without a stop date. Pt. #8's discharge instructions for a follow up appointment on 11/26/2014 do not state if the appointment was made by the nursing staff or if the patient was responsible for scheduling the appointment.

7) Per Pt. #9's MR, reviewed on 12/16/2014 at 1:00 PM, Pt. #9's discharge summary dated 12/5/2014 states in part: "Discharge Medications 1. At the time of discharge, Warfarin [blood thinner] was decreased...2. continue with Prednisone [steroid]...for 5 additional days 3. I started Pantoprazole [gastric reflux medication]..." The discharge instructions do not contain any new or changed medications, all medications are listed under "Continued Home Meds." Prednisone does not specify a stop date, there are no instructions regarding where Pt. #9 is to obtain new and changed prescriptions upon discharge. Discharge instructions for a follow up appointment on 12/10/2014 do not state if the appointment was made by the nursing staff or if the patient was responsible for scheduling the appointment.

8) Pt. #10's MR, reviewed on 12/16/2014 at 1:05 PM, contains a discharge summary dated 12/6/2014. The discharge summary states "new medications were as follows: Doxycycline [antibiotic]...to complete a 14 day course...along with Cefpodoxime [antibiotic]...also to complete a 14 day course of therapy. New medications also included ibuprofen...for a 1 week course to be taken along with Pantoprazole...while on ibuprofen. The patient was also started on Levothyroxine...indefinitely for the first time." The patient's discharge instructions lists these new medications under "Continued Home Meds", there are no stop dates listed for the medications and no follow up outpatient pharmacy instructions.

All MR review findings were verified with Staff D at the time of review.

During an interview with Staff D on 12/16/2014 at 12:35 PM, Staff D stated that the discharging provider is responsible to select medications from the electronic health record to populate the patient discharge instructions with an accurate discharge medication list. Per Staff D, new prescriptions should be identified as such on the discharge instructions.

Staff C stated on 12/16/2014 at 2:35 PM that providers are expected to complete the discharge medication reconciliation per the "Online Medication Reconciliation" instructions in order for patients to identify new and continued medications on the patient discharge instructions.