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PALMS OF PASADENA HOSPITAL 1501 PASADENA AVE S SAINT PETERSBURG, FL 33707 May 26, 2011
VIOLATION: ORGANIZATION AND DIRECTION Tag No: A1101
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record review, staff interview and policy review it was determined the nursing staff did not follow policy and procedure for the discharge of 1 (#1) of 10 sampled patients reviewed.

Findings Include:

1. Patient #1 (MDS) dated [DATE] at 7:29 p.m. by ambulance. The patients triage vitals were blood pressure of 150/91, pulse 108, respirations 18, temperature of 98.9 and pain level of 5 out of 10. The patient was assigned a triage level of IV, non-urgent and was seen in the ED Fast Track area. The ED physician assessed the patient at 7:30 p.m. The chief complaint was listed as right knee pain status post fall. The Physicians impression was knee sprain and the patient was ready for discharge at 10:01 p.m. The patient received the following radiology exams while in the ED; Computed Topography (CT) scan of the cervical spine and head, x-rays of the knees, lumbar spine, pelvis, sacrum and coccyx.
2. The Nursing discharge documentation for 4/12/11 at 9:57 p.m., revealed " the patient was discharged home, awake in no distress, taken via stretcher to his car then he was carried to his family's car for comfort. The Patients family refused to get and pay for wheelchair transport service. The family stated they will carry him to his bed from their car." There were no vital signs documented from the time of triage to the time of discharge.
a. The Director of Quality, the Interim Director of Emergency Services, the Director of Risk Management and the Chief Nursing Officer, reviewed the patient's clinical record on 5/26/11 at approximately 4:45 p.m., and confirmed the above findings.
3. A review of the Radiology report for the Pelvis AP x-ray revealed findings "suspicious for a sub capital fracture of the right femur. The findings were called to the ED physician at 8:22 a.m. on 4/13/11 by the radiologist." The patient's family was called by the ED charge nurse on 4/13/11 at 9:11 a.m., to bring the patient back to the facility.
4. An interview was conducted on 5/26/11 at 4:00 p.m., with an ED RN. The RN was questioned concerning the protocol for discharge from the ED. The RN stated that usually the patient is ambulated prior to discharge to verify they are ambulatory. The patients vital signs are obtain to ensure they are stable for discharge and that the patient's pain level is at a tolerable level. When presented with the scenario of the subject of the complaint, the nurse stated he could not see how the patient could have been discharged by stretcher. The ED MD would have to be notified if the patient was unable to ambulate.
5. A review of the policy, "Patient assessment and reassessment in the emergency department", policy # EME 010:2:1, reviewed 1/11, revealed on page 2 of 2, section B. reassessment, paragraph (4), "vital signs are to be monitored at least every 2 hours and/or indicated for patient's condition and length of stay. Vital signs will be taken and documented prior to discharge."
6. A Telephone interview was conducted with the Director of Physical Therapy (PT) on 5/26/11 at 5:00 p.m. During the telephone interview the Director was questioned concerning the initial PT evaluation following the patient's surgery on the second admission on 4/13/11. According to the initial PT evaluation the patient was " Home ambulatory " prior to the fractured hip. The meaning of "home ambulatory " according to the Director is that the patient ambulates around the home, short distances.