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Based on medical record (MR) review and interviews, it was determined the hospital staff failed to provide training to the patient/care giver regarding subcutaneous administration of Lovenox that the patient was to receive after discharge from the hospital. This affected 1 of 4 medical records reviewed (MR # 1) and had the potential to negatively affect all patients discharged from the hospital.

Findings include:

MR # 1 presented to the hospital emergency department (ED) on 6/11/13 with a complaint of a cough with muscle aches, nasal discharge and sputum production for 5 days. The patient was admitted to the hospital and treated for Group A Strep Pneumonia. The patient remained at the hospital through 8/3/13.

Review of the Discharge Medication list dated 8/3/13 revealed the patient had a prescription for Lovenox 40 MG (milligrams)/0.4 ML (milliliter) syringe that was to be administered subcutaneously every morning.

Review of the Discharge Instructions dated 8/3/13 revealed documentation the patient was given instructions regarding the medications. There was a notation on the Discharge Instruction form that the patient was unable to sign. Documentation in the MR revealed the patient was a paraplegic. Because the patient was a paraplegic, the patient would have not have been able to administer any type of injections.

Review of the medical record revealed no documentation any of the patient's care givers were instructed regarding the administration of the Lovenox or that any of the patient's care givers were assessed for competency in administering the Lovenox.

An interview was conducted on 9/5/13 at 8:25 AM with Employee Identifier (EI) # 1, the Registered Nurse (RN), who discharged the patient on 8/3/13. EI # 1 confirmed that when the Lovenox injections are ordered to be given at home after discharge from the hospital the patient or care giver should be taught how to administer the Lovenox. EI # 1 stated that the patient or caregiver first watches an instructional video regarding the Lovenox administration and then the patient or caregiver would be instructed in the administration of the Lovenox and the patient or caregiver would have to demonstrate their ability to administer the Lovenox.

EI # 1 confirmed the patient did not have any family members with him at discharge and the medication discharge instructions were given to the patient. EI # 1 confirmed the patient could not administer the Lovenox related to the patient's paralysis.

The patient was readmitted on 8/9/13 with the diagnosis of Diarrhea, Abdominal Pain and Volume Depletion. The surveyor interviewed the patient on 9/5/13 at 9:20 AM. During the interview, the patient stated that his/her care giver watched a video regarding the Lovenox injections prior to his/her discharge on 8/3/13. The patient was unable to verify that his/her care giver received any other instructions regarding the Lovenox or if the care giver ever demonstrated their ability to administer the Lovenox to the staff.

During an interview on 9/5/13 at 10:40 AM, EI # 2, Assistant Director of Quality Mangement, confirmed there was no documentation in the MR that the care giver had received teaching or training regarding the Lovenox injections. EI # 2 confirmed the training should have been documented in the MR if the training had been done.