HospitalInspections.org

Based on review of policy, medical record reviews and staff interviews, the hospital staff failed to provide patients the second notification of the right to appeal their discharge as per the IM (Important Message From Medicare) for 3 out of 5 patients (#3, #4, and #8).

Findings include:

Review of policy, "Administrative Policy, Utilization Review Plan: Discharge Planning" with approval date of 06/14/2012, revealed "For Medicare patients, the Important Message from Medicare must be issued within 48 hours before planned discharge date".

1. Closed medical record review of patient #3 revealed an 82 year old male who was admitted on 03/24/2015 with CHF (Congestive Heart Failure--condition causing fluid to gather around the heart). Record review revealed the patient was discharged on 03/28/2015. Further review revealed the IM letter signed and dated by the patient upon admission on 03/24/2015 at 1655. Review revealed no discharge IM letter in medical record. Further review revealed Medicare as listed insurance coverage.

Interview with AS #1 on 09/30/2015 at 1345 revealed discharge reports are not run daily. "We are not following all Medicare patients for discharges." Further interview revealed the hospital staff failed to provide patient #3 with the second IM notification.

2. Closed medical record of patient #4 revealed a 67 year old male admitted on 09/09/2015 with GIB (gastrointestinal bleed). Record review revealed the patient's wife signature on the admission IM letter on 09/09/2015 at 2222. Record review revealed the patient was discharged on 09/15/2015. Review revealed no discharge IM letter in medical record. Further review revealed Medicare as primary insurance coverage.

Interview with AS #1 on 09/30/2015 at 1345 revealed discharge reports are not run daily. "We are not following all Medicare patients for discharges." Further interview revealed the hospital staff failed to provide patient #4 with the second IM notification.

3. Closed medical record of patient #8 revealed a 92 year old male admitted on 08/31/2015 from home with diarrhea with discharge date of 09/03/2015. Record review revealed an admission IM letter dated 08/31/2015 at 1548 signed by family member. Record review revealed no discharge IM letter in medical record. Further review revealed Medicare as primary insurance coverage.

Interview with AS #1 on 09/30/2015 at 1345 revealed discharge reports are not run daily. "We are not following all Medicare patients for discharges." Further interview revealed the hospital staff failed to provide patient #8 with the second IM notification.

Based on policy reviews, medical record reviews, observations, staff interviews, and patient and family interviews, the nursing staff failed to follow physician's orders for the falls precautions for 1 of sampled 2 patients.(#2).

The findings include:

Review of policy: "Patient Safety--Fall Prevention Program", dated 10/18/2013, revealed "All patients will be provided with a safe physical environment by routine fall risk assessment on admission and on going evaluation of safety needs which could place the patient at risk for accidental injury....Inpatient: A. Identify patients at risk for falling using the Modified Johns Hopkins Hospital Fall Risk Assessment Tool. Patient will be scored as No risk--0-5 points, Low Risk--6-10 points or High Risk--11 or more points. Fall Prevention Strategies: A. Patient Identified as No or Low Risk for Falls. 1. Implement the following patient safety measure for all no risk or low risk patients. a. Maintain a safe unit environment, including...1. Remove excess equipment/supplies/furniture from rooms and hallways. 2. Clean all spills in patient room or in hallway immediately. Place signage to indicate wet floor danger. 3. Review current education on falls. 4. Secure brakes on beds, stretchers, and wheelchairs 5. Place call light and frequently needed objects within patient reach. Answer call bell promptly. 6. Keep floors clutter/obstacle free (with attention to path between bed and bathroom/commode). 7. Assure adequate lighting, especially at night 8. Use properly fitting non-skid footwear. 9. Supervise and/or assist bedside sitting, personal hygiene, and toileting as appropriate. ..Documentation 1. Note patient's fall risk status on the Admission Assessment and any changes in the daily assessment. 2. Reassessment and documentation of safety measures utilized will occur each shift, per reassessment and as needed."

Review of a closed medical record of patient #2 revealed a 42 year old female admitted on 03/24/2015 from the ER (emergency room) with persistent vomiting and poor po (oral) tolerance. Further review revealed an ER (emergency room) physician order for FALLS RISK: Assess and follow falls risk precautions per assessment" dated 03/22/2015 at 2329. Further review revealed completed every 12 hour fall assessments rating as "Low to High Risk" on 3/22/2015 to 03/25/2015.Further review revealed an incomplete falls assessment on 03/26/2015 at 0925 categorizing patient at "No Risk" for falls.Category of Medications Ordered for This Patient, Patient Care Equipment and Does Pt Warrant Higher Fall Risk Score were left blank and unanswered. Further review revealed patient #2 fell on 03/26/2015 at 1025.

Interview with RN #2 (primary nurse assigned to patient on day of fall) on 09/30/2015 at 1055 revealed no reason for incomplete falls assessment. "Patient should have been on falls precautions. Patient was left alone while on BSC (bedside commode)."

Interview with AS #3 on 09/29/2015 at 1600 revealed falls assessment was incomplete.

Based on review of policy, observations, and staff interviews, the facility's Infection Control Officer failed to ensure the control of infections by failing to ensure staff utilized personal protective equipment (PPE) per policy for 1 or 1 patients observed on isolation precautions. (Patient #11).

The findings include:

Review of hospital policy, "Isolation Precautions and Management of Resistant Organisms", dated 10/22/2014 revealed "Contact Precautions: In addition to Standard Precautions for specified patients known or suspected to be infected or colonized (the presence of microorganisms in or on the patient without clinical signs and symptoms of infection) with epidemiologically important microorganisms, (such as Hepatitis A, Salmonella, Shigella, abscesses or cellulitis, C-difficule, MRSA, or other multi-drug resistant bacteria) that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the dry skin), indirect contact (touching) of environmental surfaces or patient-items in the patient's environment or when uncontrolled drainage is present.....Gown--Wear a gown (a clean non-sterile isolation gown)when entering the room. Remove the gown before leaving the patient's room."

Open medical record review of patient #11 revealed a 76 year old male admitted on 08/23/2015 for AMS (altered mental status) from home with ESRD (end stage renal disease-poor functioning of the kidneys requiring dialysis), and Diabetes (condition of the pancreas with insufficient insulin production). Further review revealed a positive perirectal swab on 08/24/2015 indicating VRE (Vancomycin Resistant Entercoccus--bacteria in intestines that becomes resistant to antibiotics and can cause infections and can spread from surfaces).

Observation of RN #11 on 09/29/2015 at 1200 entering patient #11's room with prepared insulin for before meal administration. Observed signage on patient's door indicated "Contact Isolation." Further observation revealed RN #11 entered room with portable computer and stopped at designated line in floor to document in computer. RN donned gloves, no gown, from PPE station in room. RN continued past lined floor to patient's bedside and administered insulin.

Interview with RN #1 at 09/29/2015 at 1202 revealed the need for use of a gown for contact isolation patient.

Interview with AS #2 on 09/29/2015 at 1203 revealed the RN should have worn a gown in the patient's room when going past the tile marker on floor separating the required use of PPE.