HospitalInspections.org

Based on review of medical records, hospital policy and staff interview it was determined the hospital failed to ensure patients were screened for discharge needs through use of the Discharge Planning Record per hospital expectation/policy for seven (7) of ten (10) patients reviewed (patients #1, 2, 5, 6, 7, 8 and 10). This failure creates the potential for an adverse impact on the discharge needs/care of all patients. Findings include:

1. An interview was conducted with the Assistant Director of Case Management in the late morning of 8/16/10. She provided a copy of the "Discharge Planning Record" form and the Discharge Planning Policy, effective March 2009. She stated the Discharge Planning Record is utilized by Case Management to screen patients for discharge needs and is filled out on all patients within 24-48 hours of admission. She stated that if the patient is admitted on a weekend then it would be filled out on Monday. The policy states in part: "Documentation of the assessment will be recorded in the patient record."

2. Review of the medical record for patient #1, admission date 7/19/10, revealed no Discharge Planning Record.

3. Review of the medical record for patient #2, admission date 7/17/10, revealed the Discharge Planning Record was completed on 7/22/10, five (5) days after admission.

4. Review of the medical record for patient #5, admission date 7/10/10, revealed no Discharge Planning Record.

5. Review of the medical record for patient #6, admission date 7/23/10, revealed no Discharge Planning Record.

6. Review of the medical record for patient #7, admission date 8/14/10, revealed the Discharge Planning Record was completed 8/17/10, three (3) days after admission. (Patient admitted on Saturday; form completed Tuesday.)

7. Review of the medical record for patient #8, admission date 8/14/10, revealed the Discharge Planning Record was completed 8/17/10, three days after admission. (Patient admitted on Saturday; form completed Tuesday.)

8. Review of the medical record for patient #10, admission date 8/12/10, revealed the Discharge Planning Record was completed 8/16/10, four (4) days after admission.

9. During the afternoon of 8/19/10 these findings were reviewed and discussed with both the Director and Assistant Director of Case Management and they agreed with these findings.

Based on medical record review, hospital policy and staff interview it was determined the hospital failed to ensure the discharge plan was reassessed for one (1) of one (1) patient reviewed (patient #1). This failure resulted in the patient's immediate return to the hospital Emergency Department post discharge. This failure also creates the potential for the post hospital care of all patients to be adversely impacted. Findings include:

1. Review of the medical record for patient #1 revealed she was admitted on 7/19/10. Review of the 7/19/10 Nursing Admission History revealed in part the nurse noted: "no home and wants community resource information." Review of the 7/19/10 Nursing Admission Assessment revealed in part that patient had limited range of motion in her legs and used a walker at home.

On 7/20/10 the Social Worker met with the patient. She noted in part ..."Consult with patient who is homeless. Patient reports she has been staying in a hotel and is no longer able to afford it. She has also spent some time at her mother-in-law's home but doesn't think her mother-in-law wants her to return. Patient reports she is not able to get around."

On 7/23/10 the Social Worker noted in part: "Contacted patient's husband and mother-in-law...Mother-in-law refuses to allow patient to return to her home."

An interview was conducted with the Social Worker in both the afternoon of 8/16/10 and 8/17/10. She indicated she signed herself off the case as of 7/23/10.

The record contained no further notes from the Social Worker. There were no discharge planning notes made on 7/24/10, 7/25/10 or 7/26/10.

Review of the physician orders for 7/26/10 revealed an order to "Cancel discharge till tomorrow."

The record lacked any Case Management notes until 7/27/10 which was the date of discharge.

On 7/27/10 the physician wrote orders for a home health referral and for the patient to be discharged home by ambulance with oxygen.

At 1027 on 7/27/10 the Case Manager noted in part: "...attending physician...spoke with husband and informed him of discharge today and she would be returning home or to make alternate arrangements for his wife."

At 1413 the Nurse documented she called the patient's husband who was staying at his mother's house. She noted he stated the patient could not come there.

At 1700 the patient was placed in a taxi to take her to the local homeless shelter. At that time the nurse documented the patient was hesitant to leave, stating she needed a walker. The nurse noted, in part, that no arrangements were made for a walker.

At 1730 the nurse documented the taxi driver called back to report the homeless shelter would not take patient because she says she can't walk and refused to get out of taxi. The patient was returned to the hospital Emergency Department.

2. The policy 'Discharge Planning," effective March 2009, was provided for review. It states in part: "All patients will be re-evaluated as needed to ensure an appropriate discharge plan.

3. The policy "Plan for Assessment/Reassessment," effective 4/10, was provided for review. It states in part: "The patient, family, and discharge plan will be reassessed a minimum of every 72 hours throughout the hospital stay to determine if the plan needs revision or if additional assistance will be required."

4. Review of the medical record revealed the hospital failed to reassess the patient's discharge plan after 7/23/10 when it was determined she could not return to the mother-in-law's home.

5. These findings were reviewed and discussed with both the Director and Assistant Director of Case Management. They agreed with these findings.