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Based on review of policy and procedures, medical records, and staff interviews the facility staff failed to ensure appropriate discharge for a patient requiring discharge to a skilled facility in 1 of 3 patients sampled. (Patient #5)

The findingd include:

Review on 08/24/2019 of the facility policy titled, "Discharge Planning," last reviewed: 10/2018, revealed "Physicians determine the patient`s medical readiness for discharge and determine the level required for the patient upon discharge from the hospital based on the patient`s continued care needs. Physicians will communicate identified post-discharge needs and any needed changes to the discharge plan to the care team directly or via their on-going progress notes ...Social Workers ...4. Collaboration with case managers and medical staff regarding patient discharges to appropriate level of service/care for smooth patient flow and optimal outcomes. 5. Reassessment according to the guidelines established by the clinical discipline or department/program ...g. If new information arises or there is a change in the discharge plan, the decision making physician is to be notified ..."

Medical record review on 09/25/2019 of Patient #5, revealed an 87-year-old female patient with history of advanced dementia presented to emergency department on 08/08/2019 at 1919 for altered mental status and agitation. Review revealed on 08/20/2019 the decision-making physician ordered for the patient to be discharged to a skilled nursing facility. Review revealed on 08/22/2019, the day of discharge, the PA ordered for the patient to be discharged to a skilled nursing facility. Review revealed Patient #5 was discharged to a psychiatric facility.

Interview on 09/24/2019 at 1540 with Social Worker #1, revealed she had been assigned the patient on 08/20/2019. Interview revealed the Social Worker received a notification in the computer of the patient`s pending discharge. Interview revealed the notes Social Worker #1 had reviewed were from the psychiatric consult on 08/14/2019 and the previous social worker note on 08/15/2019 indicating referral and discharge to a psychiatric facility.

Interview on 09/24/2019 at 1310 with the Clinical Coordinator of Case Management, revealed the indication for the discharge to a psychiatric facility came from the last psychiatric consult note and the prior social worker notes, which were from the patient`s initial assessment by the social worker. Interview revealed that the medical doctor was the physician that wrote the discharge orders on 08/20/2019. Interview confirmed the order to discharge did not come from the psychiatric physician. Interview confirmed the physician had written for the patient to be discharged to a skilled nursing facility.

Interview on 0925/2019 at 1015 with PA #9 (Physician Assistant), revealed "I picked the patient up the day of discharge." Interview revealed on the day of her discharge, "I put skilled nursing facility. I rely on the Social Worker team to find placement per the physician orders. I did not have any knowledge she was going to a psychiatric hospital." Interview revealed PA #9 accepted and concluded the named facility placed by the social worker on the discharge papers was a skilled nursing facility.

Interview on 09/25/2019 at 1515 with Physician #5, revealed "I did not" to any order written to discharge the patient to a psychiatric facility. Interview revealed the Physician had placed an order, the last discharge order, for skilled nursing facility. "I don`t understand why she went to a psychiatric facility. Something went wrong. It was an honest misunderstanding."

NC00156120 NC156289