HospitalInspections.org

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Based on interview, record review, and review of hospital policies and procedures, the hospital failed to ensure that patients and caregivers received complete and comprehensive education and instructions for care following discharge from the hospital, as demonstrated by 3 of 5 records reviewed (Patients #1, #2, #3).

Failure to provide patients with complete and comprehensive education and discharge instructions risks improper care at home, which may result in readmission to the hospital.

Findings:

1. Review of the hospital's policy and procedure titled "Plan for Discharge Planning", no policy number, reviewed 04/10/19, showed that hospital case managers would screen all patients for discharge needs and perform a comprehensive assessment if needs were identified, including educational needs. The case manager would develop a discharge plan with input from the patient and/or caregiver.

2. Review of the hospital's policy and procedure titled "Nursing Documentation, no policy number, approved 06/01/18, showed that registered nurses would evaluate the patient's learning and educational needs and would document and evaluate patient teaching episodes in the patient's medical record, including the patient's diagnosis, disease process, associated therapies, and the patient's understanding of education provided.

3. Review of the medical records of five patients who had been discharged from the hospital between 06/02/19 and 08/06/19 showed the following:

a. Patient #1 was an 80 year-old patient who had been admitted to the hospital on 05/20/19 for treatment of aspiration pneumonia and hypoxia. The patient had also been diagnosed with type 2 diabetes mellitus. The patient was discharged to an adult family home (AFH) on 06/04/19. The patient was started on subcutaneous insulin while in the hospital. The patient's records included written discharge instructions for insulin to be given every morning. The instructions did not include instructions to check the patient's blood glucose prior to administration of the insulin. The record did not include evidence that hospital staff had verified with the AFH that the patient had a blood glucose testing meter. The discharge instructions included instructions for tube feedings but did include an order for the tube feeding formula.

b. Patient #2 was a 59 year-old patient with type 2 diabetes who had been admitted to the hospital on 05/31/19 for treatment of diabetic ketoacidosis (a buildup of acid in the blood due to high blood sugar). The patient was discharged to his home on 06/02/19. The patient's medical record did not include evidence that nursing staff had educated the patient regarding care of his diabetes. The record did not include evidence that hospital staff had verified that the patient had a blood glucose testing meter at home. The patient's discharge instructions did not include instructions for care of his diabetes.

c. Patient #3 was a 45 year-old patient with type 1 diabetes who had been admitted to the hospital on 08/04/19 for treatment of diabetic ketoacidosis. The patient was discharged to her home on 08/06/19. The patient's medical record did not include evidence that nursing staff had educated the patient regarding care of her diabetes. The patient's discharge instructions included instructions for self-administration of insulin but did not include instructions for checking her blood glucose prior to administration of the insulin. The record did not include evidence that hospital staff had verified that the patient had a blood glucose testing meter at home.

4. On 08/08/19 at 2:50 PM during an interview with the investigator, a registered nurse Epic (electronic medical record) trainer confirmed that there was no evidence that patient education and discharge instructions had been provided for the patients above.
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