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This had the potential to affect all patients served by this facility and did affect Medical Record (MR) # 1.


Findings Include:


Policy Number 274051
Reconciliation Of Medications Across the Continuum, Saint Vincent's East -Pharmacy-169

Purpose: To establish a process for comparing the patient's current medication with those ordered for the patient while under the care of the hospital.

Policy:

I. A medication reconciliation list should be collected for every patient given medication anywhere in the ST. Vincent's East Organization.

II. The medication reconciliation list for each patient should be analyzed to determine: A. For inpatients, should the drugs be stopped. continued, and/or medications added.
B. For outpatients, does the patient's home medication list conflict with planned treatments in the outpatient setting?

III. Copies of the medication list should be provided to :

C. The patient at the time of discharge from the inpatient setting

E. The patient primary care physician or next provider of care in the medications that the patient has been taking has changed.

F. Document all such occurrences as described in A-D above.

IV. The reconciliation process should include the following:

E. Before the patient is discharged, the following reconciliation
process should occur:

1. The medications that the patient was taking when admitted should be compared to the medications the patient is taking prior to discharge.

2. A decision should be made which medications should be continued post-discharge.

3. A final discharge list should be created and copies of that list provided as appropriate as outlined in III above.


Policy Number: 123806

Discharge Planning- Saint Vincent's East- Behavioral Health

It is the policy of St. Vincent's East Behavioral Health Services that discharge preparation be a priority of the treatment plan and aggressively pursued through the coordinated efforts of the staff. The discharge planning process will be initiated upon patient's admission and continued throughout hospitalization.

Procedure:

C. The discharge plan will address the individual needs of the patient be realistic and achievable, and include, but not to be limited to, the following:

4. Medications

D. The foundation for discharge planning is patient education.

2. Education will include, but not limited to, the following:
a. Self-medication: dose, time, side effects, and rational.


1. Medical Record (MR) # 1 was voluntarily admitted to the behavioral health unit of the facility on 11/18/13 and was discharged 11/22/13. Primary diagnosis for the admission included Bipolar Disorder Affective Disorder, Personality Disorder with Narcissistic features.

A physician's order was present in the medical record 11/22/13 for discharge.

Review of the Inter-Disciplinary Patient Discharge Instruction Form revealed the patient was to be discharged home with a family member. The medication reconciliation part of the form revealed the discharge nurse marked "discharge medications reconciled, copy of discharge medications given to patient (must include all medications including prescriptions) and medication sheets given to patient for new medications to be taken at home".

Review of a physician's order dated 11/19/13 revealed orders to discontinue Effexor, add Latuda 20 Milligrams (mg) by mouth (po) every PM with dinner, Lithium 150 mg po 2 times a day, change Klonopin to 1 mg every AM and 2 mg every PM and change Seroquel to 600 mg po hours sleep (hs).

Review of the Medication Administration Record dated 11/19/13 through 11/20/13 and 11/21/13 through 11/22/13 included Lithium 150 mg po 2 times a day.

Review of the Physician Psychiatric Progress Note dated 11/20/13 included the following "keep on low dose lithium".

Review of the physician's discharge summary dated 11/22/13 at 11:16 AM included "She is discharged with:
1. A new prescription for Latuda 20 mg each day at bedtime.
2. She continues on Seroquel 400 mg per day
3. Lithium Carbonate 150 mg b.i.d. (twice daily)."
Review of the prescriptions written by the physician failed to include Lithium.

Review of the Discharge Medication Reconciliation form dated 11/22/13 included all medications to be taken at home except for the Lithium 150 mg po 2 times a day. There was no documentation the physician was contacted to verify the patient was to continue the Lithium after discharge from the hospital.

An interview with Employee Identifier #1, Administrative Director Behavioral Health, confirmed the aforementioned findings.