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Based on interview and record review, Hospital #1 failed to ensure the nursing staff updated the care plan regarding a change in the clinical condition of insulin dependent Diabetes Mellitus (DM) ) uncontrolled blood sugars of 1 (P #1) of 10 (P#1 - 10) patients to the rehabilitation facility This failed practice resulted in the patient's admission to Hospital #2 after discharge from an inpatient drug rehabilitation program. The findings are:

A. Record review of the care plan for P #1 revealed there was no updated information in the care plan regarding a change in medical condition from time of admission for P #1's diagnosis of insulin dependent DM.

B. Record review of complaint document dated 09/29/17 revealed that P#1 was taken to Emergency Department of Hospital #1 by TFC personnel, then transferred to Hospital #2 due to high blood sugar levels.

C. On 10/02/17 at 2:27 pm during interview, Staff #6 stated that they consulted with the attending physician regarding abnormal labs indicating that P#1 was diagnosed as insulin dependent diabetic.

D. On 10/02/17 at 2:30 pm during interview, Staff #16 confirmed that there was no updated information regarding P#1's change in medical diagnosis of insulin dependent Diabetes Mellitus (DM) in the care plan.

Based on observation, interview, and record review, Hospital #1 failed to meet the Condition of Participation for discharge planning as evidenced by:

(1) Failing to ensure an adequate discharge plan was created to ensure a patient (P #1) of 10 (P #1-10) patients had necessary information and orders to provide support for his diagnosis of insulin dependent Diabetes Mellitus (DM) after he was discharged. The discharge paperwork did not provide orders regarding blood glucose monitoring or medication to keep his DM stable. The deficient practice caused the patient (P #1) to present to the Emergency Department Hospital # 2 with a blood glucose of 414 mg/dl, abnormally elevated (Normal blood sugars run between 80-120 mg/dl). This lead him to be sent out to Hospital #2. (refer to A800)

(2) Failing to ensure that a discharge planning evaluation was included in the plan of care regarding a new medical diagnosis, addressing any post-hospital services needed, and the availability of the services in 1 (P#1) of 10 (P #1-10) This failed practice resulted in P#1 requiring a higher level of care at hospital #2 after discharge from the hospital #1. (refer to A806)

(3) Failing to ensure that the patient, family members or interested persons were counseled (educated and trained on medications) to prepare them for post-hospital care in an inpatient drug rehabilitation program. Hospital #1 further failed to ensure that communication to the inpatient drug treatment center was documented in patients' charts for 8 of 10 patients sampled (P#2, #3, #4, #5, #6, #8, #9 and #10) This deficient practice has the potential to require sampled patients to be readmitted soon after discharge. (refer to A820).

(4) Failing to reassess the patient's discharge plan after a new diagnosis was established for Patient #1 (1 of 10 patients sampled P#1-P#10) This deficient practice resulted in Patient #1 (1 of 10 patients sampled P#1-P#10) to require higher level of care at hospitals #2 after discharge (refer to A821)

(5) Failing to transfer Patient #1's necessary medical information regarding the updated diagnoses of insulin dependent Diabetes Mellitus (DM) to the Treatment Foster Care (TFC) program. This deficient practice resulted in Patient #1 (1 of 10 patients surveyed, P#1 - P#10) requiring a higher level of care to a hospital after discharge to TFC. .... (refer to A837)

These failed practices resulted in a patient requiring advanced medical care after discharge from hospital #1 to a TFC. The cumulative effect of these systemic deficient practices resulted in noncompliance with the Condition of Participation for Discharge Planning.

Based on record review hospital #1 failed to ensure an adequate discharge plan was created to ensure a patient (P #1) had necessary information, orders and supplies to provide support for his diagnosis of insulin dependent Diabetes Mellitus (DM) (any of various abnormal conditions characterized by the secretion and excretion of excessive amounts of urine) after he was discharged. The discharge paperwork did not provide orders regarding blood glucose monitoring or medication to keep his blood sugar stable. The deficient practice caused the patient (P #1) to present to Emergency Department of hospital #1 with a blood glucose of 414 mg/dl (Normal blood sugars run between 80-120 mg/dl). This situation required he be sent out to hospital #2 for a higher level of care. This findings are:

A. Record review of Discharge Summary revealed that P# had a diagnosis of DM. The Discharge Summary, however, did not include any orders for blood glucose monitoring or medication, or supplies to maintain normal blood glucose. The Discharge Summary also included a regular diet for P#1 instead of the specialized diet for someone with DM.

B. Record review of complaint dated 09/29/17 reveals that P#1 was taken to an Emergency Department of Hospital #1 and then transferred to an acute care hospital #2 to treat P#1's glucose level of 414 mg/dl. (Normal blood sugars run between 80-120 mg/dl.)

Based on record review and interviews, the entity failed to ensure that a discharge plan evaluation included information regarding the medical diagnosis of insulin dependent Diabetes Mellitus (DM) (any of various abnormal conditions characterized by the secretion and excretion of excessive amounts of urine), addressing any post-hospital services needed, and the availability of the services in 1 (P#1) of 10 patients (P#1-P#10) This failed practice resulted in P#1 requiring a higher level of care (Hospitalization) after discharge from hospital #1.

The findings are:

A. Record Review of Patient #1's chart revealed:

1. Record review of Discharge Summary revealed that P# had a diagnosis of DM. The Discharge Summary, however, did not include any orders for blood glucose monitoring, medication, or supplies to maintain a normal blood glucose level. The Discharge Summary also included a regular diet for P#1 instead of the specialized diet for someone with DM.

A. There was no evidence of written communication regarding the new medical diagnosis of DM for P#1 was shared between the discharging facility hospital #1 and the receiving facility (TFC).

B. On 10/02/17 at 2:30 pm during interview, Staff #16 confirmed that the Discharge Summary did not include any orders for blood glucose monitoring, medication prescriptions or supplies. Staff # 16 also confirmed that the Discharge Summary included a regular diet for P#1 instead of a specialized diet for someone with DM.

C. . Review of complaint document dated 09/29/17 revealed that P#1 had received no medication, instructions nor supplies to maintain a normal blood glucose level. P#1 was taken to Emergency Department of hospital #1 by TFC personnel, then transferred to hospital #2 for treatment of high blood glucose levels.

Based on record review and interview, the entity failed to ensure that the patient, family members or interested persons were counseled (educated and trained on medications) to prepare them for post-hospital care. This deficient practice resulted in 1 of 10 (PT#1)sampled patients, (P#1- P#10) readmission after discharge. The hospital further failed to ensure that written communication to discharged agencies was documented in patients' charts for 8 of 10 patients sampled (P#2, #3, #4, #5, #6, #8, #9 and #10). This deficient practice can result in patients requiring readmission to address errors. The findings are:

A. Record review of Patient #1's chart revealed no evidence of written communication regarding the diagnosis of insulin dependent Diabetes Mellitus (DM) for P#1 between the entity and the receiving facility (TFC).

B. Record review of sampled charts, P#2, #3, #5, #6, #9 and #10's contained no note or written communication to the discharged agency.

C. Review of complaint document dated 09/29/17 revealed that P#1 had received no medication, instructions nor supplies to maintain a normal blood glucose level. P#1 was taken to Emergency Department of hospital #1 by TFC personnel, then transferred to hospital #2 for treatment of high glucose levels.

D. On 10/02/17 at 2:30 pm during interview, Staff #16 confirmed that Patient #1's chart did not have any written communication notes regarding the medical diagnosis of insulin dependent Diabetes Mellitus for P#1 between hospital #1 and (TFC) and for 8 of 10 patients sampled (P#2, #3, #4, #5, #6, #8, #9 and #10) contained no note or written communication to receiving agencies.

Based on record review and interviews, the entity failed to reassess the patient's discharge plan after a diagnosis of insulin dependent Diabetes Mellitus (DM) (any of various abnormal conditions characterized by the secretion and excretion of excessive amounts of urine), was established. This deficient practice resulted in Patient #1 (1 of 10 patients sampled P#1-P#10) to be admitted to hospital #2 . The findings are:

A. Record Review of Patient #1's chart revealed:

1. Discharge Summary reveals that P# had a diagnosis of insulin dependent DM. The Discharge Summary did not include any orders for blood glucose monitoring, medication prescriptions, or supplies for maintaining normal blood glucose levels. The Discharge Summary also included a regular diet for P#1 instead of a specialized diet for someone with DM.

2. Patient #1's chart revealed no evidence of written communication regarding the diagnosis of insulin dependent Diabetes Mellitus (DM) for P#1 between the entity and the receiving facility (TFC).

B. On 10/02/17 at 2:30 pm during interview, Staff #16 confirmed that, the Discharge Summary did not include any orders for blood glucose monitoring or medication prescriptions. The Discharge Summary also included a regular diet for P#1 instead of a specialized diet for someone with DM.

C. Review of complaint document dated 09/29/17 revealed that P#1 had received no medication, instructions nor supplies to maintain a normal blood glucose level. P#1 was taken to Emergency Department of hospital #1 by TFC personnel, then transferred to hospital #2 for treatment of high blood glucose levels.

Based on interviews and record review, the hospital failed to transfer Patient #1's necessary medical information regarding the updated diagnoses of insulin dependent Diabetes Mellitus (DM) to Facility #1 (F#1). This deficient practice resulted in Patient #1 (1 of 10 patients surveyed, P#1 - P#10) returning to a hospital (H#2) for emergent care for high sugar level after discharge to F#1. The findings are:

A. Record Review of Patient #1's discharge summary dated 09/27/17 revealed:

1. That there was no updated information regarding P#1's change in medical diagnosis of DM.
2. No communication regarding the new medical diagnosis of insulin dependent DM for P#1 was found between the discharging hospital (H#1) and the receiving facility (F#1).

B. On 10/02/17 at 2:30 pm during interview, Staff #16 confirmed that, there was no updated information regarding P#1's change in medical diagnosis to insulin dependent DM on the discharge paperwork, and that there was no evidence of written communication regarding the new medical diagnosis for P#1 was found between the discharging facility (F#1) and the receiving facility (F#1).

C. Record review of complaint document dated 09/29/17 revealed that P#1 was taken to Emergency Department of hospital #1 by F#1 personnel, then transferred to hospital #2 due to high sugar levels because P#1 did not have a prescription for insulin, a glucose monitor to check his sugar levels which prevented him from maintaining his sugar levels within a reasonable range.