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Based on staff interview and medical record review, the facility staff failed to follow physician orders for the continuation of parenteral nutrition and intravenous antibiotics, and took out the PICC (peripherally inserted central line) prior to discharge to a skilled facility for 1 of 4 patients reviewed. (Patient #1)

The findings include:

Patient #1 was an 81 year old female with diagnoses of perforated colon with localized peritonitis and C-Difficile gastroenteritis. During a complaint survey on 10/31/12 at 4:15 p.m., the Director of Quality/Risk/Regulatory Compliance provided a letter sent to the complainant in response to alleged concerns of inappropriate discharge and removal of the PICC line for treatment. The letter documental that as part of the investigative process, it was found that the discharging nurse removed the PICC line in error prior to her discharge to the skilled facility. This unfortunately required the patient return back to the facility for another PICC line insertion to continue the needed intravenous nutrition and antibiotics.

On 10/31/12 at 4:20 p.m., the Director of Quality stated the investigation was completed by the patient advocate. The letter was addressed to the complainant by the Vice President/Acting Chief Executive Officer. The Director of Quality went on to say that this was their normal process in handling patient or family grievances. This error by the discharging nurse was reviewed thoroughly with the nurse in question and the nurse was reprimanded.

Patient #1's medical records were reviewed and discussed with the Director of Case Management during the complaint investigation. The attending physician's 9/25/12 Discharge Summary indicated his desire to continue intravenous nutrition and antibiotics for 2 more weeks. Patient #1 arrived at the skilled facility by ambulance without the PICC line in place for intravenous treatment of her gastrointestinal infection and further management of her nutrition.

On the clinical notes from the Emergency room record dated 9/26/12, documentation read that the patient was taken to Interventional Radiology for a replacement of the PICC line after the discharging nurse removed the PICC line before sending the patient to the skilled facility. There were no orders to remove the PICC line upon discharge to the skilled facility from the hospital.