HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 3 patient records (Pt #3) reviewed for discharge planning, the Hospital failed to ensure that Pt #3 was discharged to the appropriate facility.

Findings include:

1. On 12/3/19, the Hospital's policy titled, "Discharge of a Patient" (revised 2/2017) was reviewed and required, "...Discharge Instructions should include: Condition of patient at time of discharge i.e vital signs...Time and method of leaving the unit and accompanied by whom..."

2. On 12/3/19, Pt #3's medical record dated 10/9/19 was reviewed and indicated:

" -Pt #3 is a 33 year old male presented to the inpatient setting with a history of poorly controlled Bipolar Disorder. Pt #3 is an unreliable historian. Pt #3 presented with a plan to overdose on medications. Pt #3 reports he has been non-compliant with his medications. Pt #3 admits having irritable mood, racing thoughts, agitation, insomnia (problems falling asleep and staying asleep) and aggressiveness. At times, Pt #3 appears to be somewhat difficult redirectable and has very pressured speech. At times, Pt #3's behavior seems to be volatile and unpredictable. In addition, Pt #3 appears to be responding to internal stimulation ..."

-The "Psychiatric Progress Note" dated 10/13/19 at 9:13 AM indicated, " ...Pt #3's mood appears to be more stable. Pt #3 is not as agitated or restless. Pt #1 is easier to redirect ..."

-The discharge order dated 10/14/19 at 7:27 AM indicated " ...Physically optimal for discharge, follow up with PCP (primary care physician) in one week...:

-The discharge instructions dated 10/14/19 at 10:50 AM noted, " ...Pt #3 will be discharged to self to a nursing home by Elite ambulance transportation ...Discharge instructions printed and given...education given related to Discharge Medications ..."

3. On 12/3/19 at 1:00 PM, an interview was conducted with the BMU (Behavioral Medicine Unit) RN (Registered Nurse) (E #2). E #2 stated that he discharged Pt #3 on 10/14/19. E #2 stated that he did not know that Pt #3 was to be discharged to a nursing home on 10/14/19. E #2 stated that he discharged Pt #3 on 10/14/19 with a bus pass. E #2 stated that he realized Pt #3 was supposed to be discharged to a nursing home when the ambulance showed up at the Hospital a few hours after Pt #3 was already discharged.

4. On 12/3/19 at 1:15 PM, an interview was conducted with the Discharge Planner for BMU (E #5). E #5 stated that he did the discharge planning for Pt #3. E #5 stated that he talked to Pt #3 on the morning of discharge and told Pt #3 that an ambulance would pick him up at 4:00 PM on 10/14/19 and take him to the nursing home. E #5 stated that he also talked to the nursing home about Pt #3's discharge. E #5 stated that Pt #3's nurse (E#2) was busy on 10/14/19 so E #5 did not tell E #2 about the ambulance transporting Pt #3 to the nursing home. E #5 stated that around 1:30 PM on 10/14/19, E #5 went into Pt #3's room to remind him of the ambulance pick up and Pt #3 had already been discharged. E #5 stated that he immediately contacted his supervisor (E#4) and reported that Pt #3 had been discharged to the street and not to the nursing home as planned. E #5 stated that he also contacted Pt #3's mother to inform her that Pt #3 was discharged to the street instead of the nursing home.