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.

PARKLAND HEALTH AND HOSPITAL SYSTEM 5200 HARRY HINES BLVD DALLAS, TX 75235 July 20, 2011
VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN Tag No: A0820
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review the hospital failed to ensure 1 of 17 patients [Patient D #11's] discharge plan was implemented prior to the discharge date of [DATE] from the Psychiatric ED [Emergency Department]. [Patient D #11] was discharged to self.

Findings Included:

The physician history and physical dated 07/14/11 timed at 01:46 AM, reflected "[AGE] year old female brought in by the police after she threatened to commit suicide by overdosing with several pills. Patient told friends she was going to kill herself no matter what. Patient agitated, hostile, verbally abusive...unable to fully assess patient..."

The after visit summary dated 07/14/11 reflected, "Nondependent alcohol abuse, unspecified drinking behavior, acute alcoholic intoxication...ED [Emergency Department] disposition...discharge...your medication...none...discharge instructions...no drugs and alcohol, crisis line phone numbers...come back if your in crisis..."

The nursing note dated 07/14/11 timed at 11:44 AM, reflected, "Patient discharged from the ED." No documentation was found indicating patient's condition at the time of discharge, who picked her up and/or how she returned home and follow-up care.

On 07/18/11 at 12:30 PM, [Staff D #15] was interviewed. [Staff D #15] reviewed [Patient D #11's] medical record. [Staff D #15] said she discharged [Patient D #11] and did not document patient's condition on discharge. She stated she forgot. [Staff D #15] stated the patient did not have shoes when she was released, so she gave her paper shoe covers and a bus pass. [Staff D #15] validated the social worker and herself failed to document discharge planning for [Patient D #11].

The Department of Emergency Services policy entitled, "Discharge from the Emergency Services Department" with a revision date of 06/11 reflected, "While the patient is in the Emergency Services Department, opportunities for patient and or family teaching should be taken and documented...the physician will be responsible for discussing the diagnosis, treatment and plan of care with the patient and documenting disposition...the physician will complete the discharge order, instructions for the patient and appropriate referral paperwork, prior to setting the patient's disposition...the nurse will discuss the discharge instructions with the patient, and confirm understanding of the plan of care and document..."

The policy entitled, "Nursing Documentation", with a revision date of 05/09 reflected, "To provide nursing documentation of the patient's clinica course...discharge planning, health care teaching, and patient response...findings/observations/interventions applicable to the patient will be documented..."