The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

GRIFFIN HOSPITAL 130 DIVISION ST DERBY, CT 06418 Aug. 15, 2012
VIOLATION: CRITERIA FOR DISCHARGE EVALUATIONS Tag No: A0800
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of clinical records, policy review, and interviews, the hospital failed to ensure that for two of five patients reviewed (Pt. #2 and #4) the screening for the need of a discharge plan was completed according to hospital policy. The finding includes:
a. Review of the clinical record for Patient #2 whose diagnoses included, in part, multiple sclerosis and a PEG tube for feedings, identified that the patient had been hospitalized from [DATE] through 8/3/2012 for aspiration pneumonia. The patient was placed on antibiotics and discharged back to the ECF (extended care facility) where he/she lived. On 8/10/12 (Friday), the patient was readmitted for hypoxia. Review of the case manager documentation dated 8/13/12, reflected that the patient was not assessed for discharge planning until Monday, 8/13/12 (72 hours later). Review of the hospital policy for high risk criteria screen identified that all patients who meet high risk criteria, in this case, patients with conditions that interfere with transfers, mobility, eating, patients readmitted within 30 days etc, will be screened within 24-48 hours of admission.
During interview on 8/15/12 at approximately 2:06 PM, the Director of Case Management identified that the case manager working on Saturday 8/11/12, was most likely overwhelmed with discharges and new admissions.
b. Review of the clinical record for Patient #4 admitted on [DATE] identified diagnoses that included, in part, pneumonia, myocardial infarction and GI bleed. Review of the case manager's documentation dated 5/15/12, identified that the patient was screened for discharge planning. Patient #4 was discharged on [DATE] and readmitted on [DATE]. No case manager documentation could be located. During interview on 8/15/12 at approximately 3:00 PM, the Director of Case Management stated that the electronic documentation was not saved in error by a new case manager.
VIOLATION: DISCHARGE PLANNING NEEDS ASSESSMENT Tag No: A0806
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record reviews, interviews and policy review, the facility failed to ensure that for five of five clinical records reviewed (Patient's #1 , 2, 3, 4, 5) a comprehensive discharge planning evaluation was completed on each patient. The findings include:

a. Review of the clinical record for Patient #1 identified that the patient was admitted on [DATE] for a total knee arthroplasy. The patient was discharged on [DATE] and readmitted on [DATE] with a swollen, painful leg. Review of the discharge assessments dated 8/1/12 and 8/8/12 failed to address the following: that the patient's post discharge care needs could be met in the environment from which he/she entered the hospital, an assessment of the patient's or support person's ability to provide care, an assessment of whether the patient would require specialized medical equipment or modification to the home environment, and an assessment of the patient and/or support person's ability to meet the care needs, or an assessment of community based services available. The care management assessment failed to reflect that an evaluation of the prior facilities capability to provide the necessary post hospital services or an assessment of the patient's insurance coverage and how that coverage might affect the services required by the patient. Interview with the Manager of Case Management on 8/15/12 at 11:30 AM indicated that staff would document in a narrative note if there was an issue, but staff do no document what is actually reviewed. Review of the facility discharge planning policy failed to identify the specific areas that should be addressed as part of the discharge planning assessment.


b. Review of the clinical record for Patient #2 identified that the patient who had diagnoses that included, in part, multiple sclerosis and seizure disorder, failed to have a post discharge needs assessment. Review of the case manager documentation reflected only that the patient would return to the ECF (extended care facility) where he/she resided with the consent of a family member. Clinical record documentation failed to reflect that the ECF was assessed to met the necessary post-hospital needs of the patient. Additionally, although the care management assessment identified the patient's insurance source, the assessment failed to reflect how that coverage would (or would not) affect the care requirements of the patient.

c. Review of the clinical record for Patient #3 identified that the patient was admitted for substance abuse problems on 5/15/12 with readmissions from 5/27/12 to 5/31/12, 7/8/12 to 7/14/12, 7/15/12 to 7/19/12 and 7/21/12 to 7/26/12. Review of the discharge assessments for each admission failed to address that the patient's post discharge care needs could be met in the environment from which he/she entered the hospital, ability to perform his/her activities of daily living (ADL's), an assessment of the patient's or support person's ability to provide care, an assessment of the whether the patient would require specialized medical equipment or modification to the home environment and an assessment of the patient and/or support person's ability to meet the care needs or an assessment of community based services available. The care management assessment failed to reflect an assessment of the patients insurance coverage and how that coverage might affect the services required by the patient.


d. Review of the clinical record identified that Patient #4 was admitted on [DATE] with diagnoses that included, in part, pneumonia, myocardial infarction and GI bleed. Review of the case manager's documentation dated 5/15/12, identified that the patient was screened for discharge planning, however, that documentation could not be found. The documentation reflected that the patient resided in an ECF and would return there post discharge with the family's consent. Although the patient was placed in hospice from 5/24/12 through 5/31/12, within the hospital, the case manager's documentation failed to reflect that aspect of the patient's care. Review of case manager's documentation reflected notes written on 5/15, 5/21 and 5/31/12. According to hospital policy, the case manager would document "at least every three to four days and whenever a change occurs." Patient #4 was discharged on [DATE] and readmitted on [DATE]. No case manager documentation could be located. During interview on 8/15/12 at approximately 3:00 PM, the Director of Case Management stated that the electronic documentation was not saved in error by a new case manager.

e. Review of the clinical record for Patient #5 identified that the patient was admitted three (3) times during the period of 5/6/12 through 6/12/12 from home for increasing debilitation and urinary tract infection. Review of nursing documentation from the second admitted d 6/3/12 through 6/9/12 identified that the patient was discharged on [DATE], however, the patient's son could not transfer the patient from the wheelchair to the car. Although the patient's discharge was canceled and case management notified of the need for a continuing care needs assessment, the record failed to reflect that post discharge needs were assessed and planned. The patient was discharged on [DATE] and readmitted to the hospital on the same day secondary to the inability of the caregiver to meet the patient's needs.
VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN Tag No: A0820
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**







Based on clinical record reviews, interviews and policy review, the facility failed to ensure the implementation of Patient's discharge plan that for 1 of 5 patients (Patient #3), and failed to ensure that medications prescribed for 1 of 5 patient (Patient #2) directed the correct mode of administration for the patient The finding includes the following:

a. Review of the clinical record for Patient #3 identified that the patient was admitted on [DATE] with readmissions on 5/27/12 to 5/31/12, 7/8/12 to 7/14/12, 7/15/12 to 7/19/12 and 7/21/12 to 7/26/12. Review of the 5/15/12 admission identified that the patient presented to the ED for symptoms related to alcohol withdrawal. Review of the 5/17/12 care management note indicated that an inpatient rehabilitations facility was reviewed with the patient and family and that the patient would have to call for an interview after discharge. Review of the 5/18/12 note and the discharge instructions failed to identify that the details had been provided to the patient. Review of the physicians discharge summary dated 5/19/12 identified under the discharge plan, "follow-up with Case Management." The clinical record failed to reflect the aftercare instructions for Patient #3.

The patient subsequently returned to the facility on [DATE] and was readmitted for symptoms related to alcohol withdrawal. Review of the the 5/31/12 case management note indicated that Patient #3 stated he/she had no memory of the previous plan and thought he/she was scheduled at the intensive outpatient program (IOP). Interview with the Case Manager on 8/15/12 at 1:20 PM identified that she "probably" called to the inpatient program but if there were no beds available, the patients would be responsible to follow-up once discharged . The case management note dated 5/31/12 indicated that the Case Manager spoke with Patient #3's sister and the sister would encourage the patient to call to arrange aftercare. Review of the note and discharge instructions dated 5/31/12 failed to identify who the patient was to call, phone numbers and/or a discharge plan for the patient.

Review of the Case Management mission statement indicated that case management would provide a comprehensive discharge plan and case management services. The Case Manager would provide assistance in the implementation of the discharge plan.


b. Review of the clinical record for Patient #2 identified that the patient was admitted on [DATE] with the diagnosis of aspiration pneumonia. The patient had additional diagnoses that included, in part, multiple sclerosis and status post PEG tube placement for nutrition and medication. The patient was to receive nothing by mouth (NPO). Review of the home medications prescribed upon discharge from the hospital and reviewed by the attending physician included Augmentin 875 mg twice a day by mouth.

During interview on 8/14/12 at 1:50 PM, the Manager of Case Management stated that the medication reconciliation was a interdisciplinary process and should should have been reviewed by the team before the attending physician signed the discharge instructions.
VIOLATION: TRANSFER OR REFERRAL Tag No: A0837
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record review and interview the facility failed to ensure that the necessary medical information was provided to the receiving facility. The findings include the following:

Review of the clinical record for Patient #1 identified that the patient was admitted on [DATE] for a left total knee replacement. Review of the physicians discharge summary indicated that the patient had mild tenderness and pain of the left knee. The summary indicated that an ultrasound of the leg was ordered to rule out a deep vein thrombosis (DVT) prior to discharge. The discharge summary identified that the patients staple should be removed "around day 14 post operatively" and failed to identify when the patient should be re evaluated by the surgeon. Review of the W-10 and the discharge instructions failed to identify any issues with Patient #1's leg/knee. The patient was discharged on [DATE] and readmitted on [DATE] with a swollen, painful leg. Interview with Patient #1 on 8/14/12 at 10:30 AM identified that within the first 2 two days after discharge, the left knee was swollen and painful.
VIOLATION: REASSESSMENT OF DISCHARGE PLANNING PROCESS Tag No: A0843
Based on clinical record reviews, interviews, and review of facility policies for 5 of 5 readmission records, the facility failed to have a mechanism in place to evaluate whether the readmissions were preventable. The finding includes the following:

Review of Patients #1, #2, #3, #4 and #5's clinical records failed to reflect that an evaluation was completed at the time of readmission to the hospital as to whether the readmissions were potentially preventable. Interview with the Manager of Case Management on 8/14/12 at 10:00 AM indicated that the hospital does not have a policy in place presently to address readmission evaluations. The Manager indicated that all readmissions are tracked and that congestive heart failure (CHF) readmissions are retrospectively reviewed at this time.