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GREATER BALTIMORE MEDICAL CENTER 6701 NORTH CHARLES STREET BALTIMORE, MD 21204 Aug. 6, 2014
VIOLATION: INTEGRATION OF OUTPATIENT SERVICES Tag No: A1077
Based on review of the medical record, staff interviews and policy and procedures, it was determined that the hospital does not have a process or procedure for referral of the patient (other than oncology) in the outpatient infusion center requiring assessment and evaluation for non-emergent conditions.

Based on review of patient #1's medical record, staff interviews and policy and procedures, it was determined the hospital failed to provide appropriate assessment of the patient after a fall in the parking garage.

Patient #1 fell over the cement barrier in the parking garage on her way into appointment for iron infusion. The patient informed the nurse in the infusion center of her fall as evidenced by the outpatient fall risk assessment tool. The patient stated she fell on her left side scraping her left knee. Her vital signs were taken, IV inserted and infusion completed. The patient went home but due to worsening pain on her left side, she returned to the Emergency Department at which time an incident report was completed and security notified per protocol. The patient was again discharged after assessment by the ED and provided pain medication. The patient returned to the ED again with pain and vomiting. This time she was admitted . The hospital failed to have a process in place to ensure communication between outpatient and inpatient services and coordination of care and treatment for patients with non-emergent conditions. In the case of patient #1 the failure to evaluate and investigate the patient fall resulted in: 1) failure to assess a possible unsafe condition in the parking lot, failure to assess the patient after a fall, and failure to complete an event report, which is the hospital mode of communication with security, quality and risk department.