HospitalInspections.org

Based on interview, record review, and review of facility policy it was determined the facility failed to provide adequate discharge planning for one (1) of ten (10) sampled patients (Patient #1). Although the facility was aware the patient was homeless upon admission, the facility failed to ensure the patient received appropriate aftercare placement during his/her hospital stay.

The findings include:

Review of the facility policy titled "Discharge Planning Process," dated October 2015, revealed beginning upon admission, discharge planning was a multidisciplinary process to improve the quality of care for patients by insuring continuity of care and successful reintegration into the community. The process should be documented in the progress notes, psychosocial treatment team minutes, and discharge planning log.

Review of Patient #1's medical record revealed the facility admitted the patient on 01/21/17 to the facility's psychiatric center with diagnoses including Mood Disorder, Below the Knee Amputation (BKA), and Diabetes. Review of the patient's Initial Treatment Plan, dated 01/21/17, revealed the patient experienced limited family support, limited education/cognition skills, limited ambulation/transportation, and was homeless. Further review of the Initial Treatment Plan revealed the patient would require discharge planning for post treatment placement.

Further review of Patient #1's medical record revealed the patient had been a resident of a nursing facility two (2) days prior to coming to the facility. Review of the facility Placement/Referral Log revealed on 01/23/17 placement was attempted at the nursing facility where the patient previously resided; however, the nursing facility would not readmit the patient. Further review revealed on 02/07/17 placement was attempted at a Community Mental Health Center; however, placement was not successful. Review of the Progress Note, dated 02/07/17, revealed Patient #1 was "intrusive, demanding, and blames staff" related to not having placement. Further review of the medical record revealed Patient #1 left the facility on 02/07/17, against medical advice (AMA) without transportation, medication, or placement (a period of seventeen days after admission).

Interview with the facility Discharge Planner on 02/15/17 at 2:41 PM revealed several attempts were made to find placement for Patient #1; however, the patient refused to provide consent or refused the placement. There were only two attempts documented. The Discharge Planner stated she had been trained to document all placement attempts on the Placement/Referral Log but failed to document all attempts and refusals.

Interview with the Director of Nursing on 02/16/17 at 4:18 PM revealed discharge planning and placement of patients was expected during their hospital stay. The DON stated documentation should have been provided for all placement attempts and progress achieved with discharge planning efforts on the facility Placement/Referral Log. The DON stated she expected Patient #1 to receive aftercare placement during his/her hospital stay.