HospitalInspections.org

Based on record review and interview the facility failed to ensure discharge planning and evaluation of the patient's ability to care for him/her self-had been integrated into outpatient services. Findings:

11/18/17

Record review on 12/5/17 revealed Patient #6 was brought in by his parents and admitted to the Emergency Department (ED) on 11/18/17 at 4:25 pm with "Acute Psychosis."

Review of the "Emergency Department Physician" note, dated 11/18/17 at 4:29 pm, revealed the Patient was brought to the facility by his parents after having bizarre behavior. The report stated the Patient was discharged from a local inpatient psychiatric facility "5 days ago and has been living at home with his parents ... He will be admitted to ED psychiatric observation for reevaluation."

The Patient was admitted to Psychiatric observation on 11/18/17 at 7:53 pm.


Review of the Licensed Professional Counselor (LPC) "Suicide/Violence Risk Assessment," dated 11/18/17 at 8:14 pm, revealed the LPC interviewed the parents who stated the Patient "whispered I wish I could kill myself." In addition, the Patient stated to the LPC that his parents had brought him to the ED because "he needs protection."

Further review of the initial assessment completed by the LPC revealed:

"Psychosocial history ...currently lives with his parents ... is married but wife is incarcerated ...;

Suicide Risk Assessment ...Protective Risk Factors: marriage ... Violence Risk assessment: ... Protective factors: supportive parents, marriage. Psychosocial history: ...is married but his wife is incarcerated on child sex abuse charges ..."

11/19/17

Review of the "Psychiatric Observation Discharge Impression," completed by a Medical Student on 11/19/17 at 1:58 pm and co-signed by the Mental Health Specialist, revealed:

"Mental Status Exam: ...Mood is depressed, and affect is consistent with mood. Thought processes are bizarre. Thought content shows delusional, obsessive, and paranoid thinking ...Insight and judgment are poor ...

Plan: Patient is discharged from the ED with cab vouchers, warm clothing, and shoes to return to his home...Patient will discharge and parents will continue to seek disability services."

Review of the ED Provider Notes dated 11/19/17 at 2:15 pm revealed a discharge summary that stated " ...His parents are supportive and agreeable to taking the patient home ...at this time the patient is medically and psychiatrically cleared for discharge ..." The date of discharge was 11/19/17 at 15:58 (3:58 pm).

In addition, the medical record did not reveal if the Patient had been asked if he wanted to designate a caregiver to review his discharge planning with.

During an interview on 12/5/17 at 3:30 pm the Psychiatric Emergency Department Manager (PEDM) stated the parents arrived at the facility at approximately 4:00 pm to pick up their son. At that time, they found he had been discharged via a taxi cab home. The PEDM confirmed there was no documentation in the medical record that the Patient's parents were notified or that there was an attempt to contact them prior to the Patient's discharge, even though the facility was aware the parents were involved in his care.

During an interview on 12/5/17 at 4:35 pm the Service Excellence staff (SE) stated the parents of Patient #6 arrived at the hospital on 11/19/17 around 4:00 pm to see the Patient and were upset he had been discharged to home without their knowledge as they understood he was going to be at the facility until 4:00 pm.

In addition, the SE staff stated she assisted the parents to find out which address the taxi cab took the Patient to upon discharge. The address provided from the Taxi Company was the Patient's personal home. On admission to the ED the documentation revealed the Patient had been living with the parents, at a different address since discharge from a local inpatient psychiatric facility 5 days prior.

Review of the multiple Emergency Department admissions from 9/10/17 - 11/18/17 provided by the facility revealed:

9/10/17 at 7:18 am - BIB (Brought in By) APD (Anchorage police Department) for chief complaint of agitation and psychotic symptoms. The Patient was discharge/transferred on 9/12/17 to a local inpatient psychiatric facility.

11/4/17 at 5:45 am - BIB parents with chief complaint of suicidal and homicidal. The Patient was discharged on 11/6/17 to a local inpatient psychiatric facility at 8:02 am.

11/15/17 at 1:56 am - Brought to the ED by parents for chief complaint of overdose (medications). The Patient had "immediately notified his parents and they took him directly to this ED." The ED Provider Notes stated the Patient was ready to go home at 4:43 am. The note did not specify if the Patient went home with his parents.

11/15/17 at 11:37 am - Brought to the facility ED by parents for a psychiatric evaluation and discharged with the parents at 12:45 pm.

During an interview on 12/5/17 at 4:30 pm the Compliance Officer when asked to show the surveyor in the EMR where staff in the ED/Behavioral Health documented if the patient wanted discharge instructions reviewed with a designated representative, stated the flowsheet for that documentation was not accessible in the electronic record for those 2 area's. In addition, she stated it was not likely training had been done with the ED or the Behavioral Health Unit staff regarding the Alaska Care Act or for collecting information to share discharge instructions with a personal representative/caregiver.

POLICY

Review of the facility policy "Assessment/Re-Assessment of Patients" dated 6/2015 revealed "Alaska Care Act - ... is a law requiring hospitals to provide admitted patients an opportunity to designate a caregiver to continue providing aftercare to the patient following hospital discharge to a private residence ... within 24 hours of admission, the nurse documents designated caregiver name and contact information ..."

SB 72: Alaska Care Act

"18.20.510 - Before discharging a patient, a hospital shall assess the patient's ability for self-care after discharge and provided the patient with the opportunity to designate a caregiver who agrees to provide aftercare for the patient in a private residence after discharge ..."