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.
|MEMORIAL MISSION HOSPITAL AND ASHEVILLE SURGERY CE||509 BILTMORE AVE ASHEVILLE, NC 28801||Oct. 9, 2014|
|VIOLATION: TRANSFER OR REFERRAL||Tag No: A0837|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on hospital policy review, medical record review, internal document review and staff interview, the hospital staff failed to ensure discharged hospital patients received ordered post-hospital care by verifying a receiving facility had medications and supplies to meet the patient's discharge needs in 1 of 1 sampled patients discharged to another facility with post-hospital intravenous medication orders (Patient #2, RN (Registered Nurse) #1).
Review on 10/08/2014 of the hospital's policy and procedure "Discharge Planning Overview" (revised 05/08/2014) revealed "1. The care management (CM) staff will ensure that appropriate copies of medical records are made prior to the anticipated discharge time, and will arrange for transportation needs. Staff will send electronic communication message to unit to copy chart in preparation for transfer to SNF (Skilled Nursing Facility). 2. Change in patient plan of care, medication, etc from time of facility acceptance to date of transfer to the facility will be communicated by CM staff to the facility prior to discharge." The review of the policy revealed no other information for when the CM staff is not available at the hospital after their working hours are completed and the patient's are discharged to facility's after the CM working hours.
A closed medical record review on 10/08/2014 for patient #2 revealed the patient was admitted on [DATE] with a diagnosis of "Empyema, Pneumonia, Diabetes, COPD (Chronic Obstructive Pulmonary Disease), and chronic Atrial Fibrillation". Review of the patient revealed the patient was administered the intravenous (IV) antibiotic medication "Merepenam" while in hospital along with oral antibiotic medications. The documentation from the physician's discharge summary revealed the patient was to be discharged from the hospital after starting on the IV "Merepenam" before discharge to a SNF with the same therapies (IV infusion) and follow up by infectious disease physicians. The patient was discharged from the hospital with a PICC (Temporary IV insertion catheter) intact for the SNF to use. The patient was discharged from the hospital to the SNF on 08/11/2014. Documentation review in the medical record revealed the hospital's CM staff electronically provided the SNF a "provider link" of information on 08/07/2014 that did not include the IV antibiotic "Merepenam" that was not ordered at that time. Further review for 08/11/2014 revealed the hospital's staff nurse (RN #1) telephoned the facility at 1902 (after CM working hours) with report of the patient being discharged and transferred to the facility. No documentation was found that the RN made the facility aware of the need and availability of the IV antibiotic "Merepenam". The review revealed the patient was transferred to the facility and the medication information was sent with the patient to the facility for review by the facility upon arrival of the patient.
Further review on 10/09/2014 for patient #2's internal documentation and follow up review revealed "The patient was transferred to the SNF for skilled nursing care. The staff at the SNF reported to the hospital on [DATE] that the IV "Merepenam" was not on the patient information (Provider Link on 08/07/2014) received with referral." The IV medication was listed on the discharge paperwork sent with the patient to the SNF, but no advanced information was presented to the facility. The investigation revealed the patient did not receive her IV antibiotic at the SNF and was brought back to the hospital for outpatient insertion of a PICC placement since the original PICC was discontinued at the SNF. The patient was documented as returning to the hospital on [DATE] for the PICC insertion. The documentation from the infectious disease physician group revealed the patient would have to remain at SNF for an additional three (3) weeks to receive the IV antibiotic due to the mistake.
Interview on 10/08/2014 at 1550 with RN #1 revealed that she did perform the discharge for patient #2 on 08/11/2014 from the hospital. The interview revealed that she did not remember specific information about the patient but after reviewing her documentation did telephone the LPN (Licensed Practical Nurse) at the SNF with discharge instruction. The interview also revealed that she did not inquire whether or not the SNF had the availability or not start the IV antibiotic as the discharge planners take care of that part. The interview confirmed that there is no system in place to ensure that a receiving facility has the medications or supplies when patients are discharged to those facilities after the discharge planning staff has left the hospital and is no longer working.
Interview on 10/09/2014 at 0917 with the hospital's "Executive Director of Care Management" revealed "We have staff through 5 pm and the previous information is sent during the admission and before discharge. We may need to change the system for discharge to ensure that after 5 pm there is no missing information." The interview revealed the finding and need for system change to ensure that patient's discharged from the hospital after discharge planning hours are able to receive their post-hospital ordered care.