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Based on interview and record review, the discharge plan for 2 of 4 discharged patients (#15 and #17) did not contain arrangements for the initial implementation of the patient's discharge plan, including family members, to prepare them for post-hospital care, increasing the risk of unsafe discharge for all patients. Findings include:

Patient #15
Family Interview:
On 1/7/14 at 2:15 pm the parent of a minor patient (#15) was interviewed by phone. The parent stated that there was a family meeting within 2 days of admission but that no other communication (meetings or phone calls) to plan for discharge and set the date, occurred prior to the discharge date. The parent stated that one of the medications ordered at discharge (Vyvanse) could not be dispensed by the pharmacy because the insurance company would not authorized payment The family member stated that she called the patient's unit for help with this problem but nobody returned the call.

Record Review/Interview:
On 1/8/14 at approximately 2 pm, staff D, stated that the "Social Work Discharge Note," dated 10/22/13, stated that patient #15 was discharged home on 10/21/13 with a 30-day supply of Vyvanse 40 mg. and Remeron 30 mg. Staff D stated that this was incorrect. Staff D stated that the patient actually went home with no medication, only prescriptions. There was no note correcting the error or stating that the patient's family was informed of the details of discharge and setting a date, in advance of the discharge date. There was no note documenting the family member's post-discharge phone call.

Patient #17
Family Interview:
On 1/6/14 at 4:40 pm the parent of a discharged minor patient ( #17) was interviewed by phone. The parent stated that the patient called home on 10/21/13, at approximately 12 noon, and that this was the first notice of the discharge date provided.. The parent stated that at approximately 1 pm she called the facility to verify that the discharge had been approved.. The parent stated that staff I returned the call at 6:34 pm "saying that the patient was released and was waiting at the door to go." The family member stated that the patient was upset and that the family needed notice to plan transportation home for the patient.

Record Review & Staff Interview:
On 1/8/14 at 1:55 pm all documentation pertaining to patient #17's discharge were reviewed with Staff D. There was no documentation of the patient's parent's being informed by staff of a confirmed date of discharge until the actual date of discharge (10/21/13). Staff D stated that there should have been a "Discharge Note," by Social Work, documenting discharge plans and communications with the patient's family to finalize discharge plans. Staff D verified that this documentation was not included in patient #17's record.

Policy Review:
On 1/8/13 at 4 pm review of the facility's policy titled, Discharge Planning Protocol Policy, dated 7/11, revealed the following statement:
Procedures:
B. "The Social Worker will:
2. Be responsible to do the following:
a Schedule discharge conferences"
3. ADDITIONAL STANDARD FOR ACUTE PROGRAMS...
b. "Involve family in discharge planning, speaking to family (whenever possible) regarding discharge plans prior to discharge."