HospitalInspections.org

Based on interviews and medical record review,
the hospital failed to include the patient's
caregivers in making decisions in developing the
patient's care plan/discharge plan. This was
observed in 1 of 10 medical records review.
It was observed in P1's medical record.

Failure to include patient caregivers in
participating in developing patient's
discharge plans care plan violates the
patient's and caregiver's rights in making
appropriate decisions regarding patient's
discharge care plans.





Findings:

1. On 01/21/2010, during a telephone call,
the patient's caregiver reported that s/he
was not trained by hospital staff in using
oxygen equipment that was needed for
the patient's home care prior to patient's
discharge.

2. On 01/25/2010, review of patient's educational
document did not include that the patient's
representatives were asked to learn about
administering the patient's oxygen.
The hospital did schedule and coordinated
a specific oxygen service to come and
teach the patient about oxygen usage on
11/20/2009. The patient representatives
were not told or encouraged to attend the training.

3. The Risk Manager reported on 01/22/2010
the nurse documented on the Medication
Reconciliation Form that oxygen at 2-4 liter
was to be given 24/7. Review of the nursing
documentation on the discharge form did not
discuss that caregivers were taught about
setting up oxygen tank, how to turn on /off the
stopcock on the oxygen tank etc. The family
caregivers were not comfortable in going home
with oxygen treatment. The nursing staff are
responsible for coordinating patients discharge
and instructing the patient and family about
discharge care and treatments prior to
discharge. This was not adequately done
prior to discharge.

Based on interviews with administration,
an outside agency provider, review
of medical records and policy review,
the hospital failed to adequately
document discharge instructions to
patient caregivers prior to discharge.
This was observed in 1of 10 patient's
records and was observed in P1's
discharge record.

Failure to provide adequate discharge
instructions to caregivers does not
assure that patient's discharge plan
will be coordinated and effectively
implemented causing potential adverse
health conditions to the patient.

Findings.


1. On 01/21/2010 during a telephone call,
the patient's caregiver reported that s/he
was not trained by hospital staff in using
oxygen equipment prior to patient's discharge.

2. Review of the patient's medical record
documentation entered on the
Case Management Record dated 11/19/2009.
The documentation determined the social
worker and discharge planner RN met with the
family members several times. The family
caregivers discussed the patient's discharge
plans. The family caregiver wanted the patient
to stay in the hospital for another night to meet
the 3 night criteria so patient could be
discharged to a nursing skilled facility.
The discharge planner RN explained
the patient did not meet the Medicare
discharge criteria to discharge the patient to
a skilled nursing facility. The family caregiver
decided to take the patient home with
supplemental oxygen, with home health
RN care. The physician's order documented
the patient ws to be on 2.5 liters of oxygen
continuously 24/7 hours via nasal cannula.
The patient was to follow-up with primary
care provider and the patient's son-in-law
discussed the plan with the hospitalist.
On 11/20/2009 at 1600 the patient was
discharge in stable condition with oxygen
with family via private car.

3. On 01/22/2010 at 10:30, during an
interview with the Risk Manager and
Respiratory Manager, they explained the
hospital uses three different oxygen
providers that serve patients home care
oxygen needs. They said the family chose
to use the Pacific Pulmonary Service and
the hospital did not have any agreements
with this oxygen service because the patient
pays for this service. The hospital's
Cardiopulmonary Respiratory Service set-ups
the referral and it was set-up for the
Pacific Pulmonary Service Patient Care
Coordinator to come to the hospital on
11/20/2009 to teach the patient about
using portable oxygen that was to be sent
home with her/him. The respiratory therapist
faxed the patient's discharge oxygen orders to
the service. Review of the Oxygen Provider Log
documented the provider came to the patient's
room to teach the patient about the use of oxygen
and how to use the oxygen equipment.
The Respiratory Log identified the name of the
patient and the provider's name that came to the
patient's room to instruct the patient how to use
oxygen and equipment.

4. On 01/22/2010 at 11:30, the provider was
escorted by Respiratory Manager to the office
and introduced the oxygen service provider to
the investigator. During the interview, the
investigator asked how long the provider had
been working for the company. The provider
replied 6 years in Portland, Oregon.
The provider explained and demonstrated how
to turn on the oxygen tank. It could provide
4-6 hours of oxygen if the patient was receiving
3 liters of oxygen. The provider demonstrated
that if the stopcock was turned to the left this
opened the oxygen tank valve. If the stopcock
was turned to the right it turned it off. S/he
explained the patient was to dial in the amount
of oxygen by turning the knob that was on the
side of the oxygen tank. The provider
remembered the patient and reported the patient
could not demonstrate back the instructions to
him/her. The provider reported that s/he reported
to the charge nurse the patient did not
understand the instructions about using the
oxygen tank equipment.

5. On 01/25/2010, I reviewed the patient's
Educational Plan Assessment Form.
The review detetmined the admission
nurse identified the patient's learning
assessment score measured 4. This met
the patient had a cognitive/sensory
impairment problem. This would cause
the patient to have a learning barrier when
using medical equipment. Also, the nurse
documented the patient would require
"a lot of reinforcement."
The documentation on the form did not
identify that patient's caregiver would be
involved with patient's oxygen training.

6. On 01/25/ 2010, I reviewed a policy titled,
"Discharge Plan Policy". The policy was reference
#922.00 and it was revised on 04/2008 by
administration. The review identified a paragraph
titled "Planning Section" found on page 2 of 3 and
in point 5-D it read: "The Registered Nurse will:
assure that barriers to patient learning are
addressed and that education is completed."
The hospital failed to complete the patient's
discharge by providing home oxygen equipment
training to the caregivers prior to discharge.
The patient's discharge plans were not
coordinated with plan of care. The patent's
caregivers were not assisted in feeling
comfortable in using oxygen equipment prior to
discharge. Also, the hospital failed to follow
the written discharge policies.