HospitalInspections.org

Based on clinical record review and interview, it was determined the Facility failed to complete the Patient Transfer Record for five (#2-#6) of six (#2-#6 and #8) patients reviewed who were transferred to another Facility. The failed practice did not ensure the patients were fully informed of transfer process. The failed practice had the potential to affect all patients transferred to another Facility. The findings follow:

A. Review of Patient #2's Patient Transfer Record on 08/31/16 revealed the Date/Time Accepted to the accepting Facility was blank.

B. Review of Patient #3's Patient Transfer Record on 08/31/16 revealed the Nursing Report Given To and the Nursing Report Given By were blank.

C. Review of Patient #4's Patient Transfer Record on 08/31/16 revealed the Referring MD (physician), Patient's/Patient's Representative Signature and Date/Time and the Signature of Transferring Physician were blank.

D. Review of Patient #4's Patient Transfer Record on 08/31/16 revealed the Receiving Hospital Contacted (Date/Time), Person Authorizing/Accepting Transfer, Title of Person, Date/Time Accepted, Receiving MD, Phone, Contacted (Date/Time), Accepted (Date/Time), Section 2, Section 4, Patient's/Patient's Representative Signature and Date/Time of signature were blank.

E. Review of Patient #5's Patient Transfer Record on 08/31/16 revealed the Receiving MD's Phone number, Contacted (Date/Time), Accepted (Date/Time) and Nursing Report Given To were blank.

F. Review of the policy "Transfer of Patients Including Trauma Patients Policy" provided on 08/31/16 revealed the following:
"Transfer of Patients to Another Facility:
Before the patient leaves NHS (Northwest Health Systems), the Nurse will:
a) Contact the transfer center when appropriate
b) Contact an appropriate nurse at the receiving Facility to provide adequate and timely report on the patient's condition, and to verify bed/staff availability in the receiving hospital.
c) Complete the "Patient Transfer Record". Send a copy of each with the patient. The original should be retained on the NHS patient chart. Documentation should include:
1. The name(s) of the NHS personnel who contacted the receiving Facility.
2. The name of the receiving facility.
3. Any physician-to-physician contact between the two hospitals.
4. The fact that the receiving hospital stated that it had available space for treatment of the patient.
5. The fact that the receiving hospital stated it had available qualified personnel for treatment of the patient.
6. The fact that the receiving hospital agreed to accept transfer of the patient and to provide appropriate medical treatment.
7. The name and title of the consenting party at the receiving hospital.
8. The position or responsibility of the consenting party at the receiving hospital.
9. The date and time of the consent of the receiving hospital.
10. The information given to the receiving hospital concerning the patient's suspected diagnosis (include any suspected or known infectious processes), condition, mode of transportation, expected time of arrival, etc.
a) The hospital or health care Facility will send information (as noted in #10 above) with patients transferred to NHS.
11. Complete the Nursing Discharge summary and all other appropriate documentation on the patient.
12. Inform patient of transfer details, and reinforce physician's explanation of rationale. Re-assure patient that his/her established care will continue after the move to another facility."

G. The findings of A, B, C, D and E were confirmed in an interview with the Director of Quality on 08/31/16 at 1005.