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BAYLOR SCOTT & WHITE MEDICAL CENTER- COLLEGE STATI 700 SCOTT & WHITE DRIVE COLLEGE STATION, TX 77845 Jan. 15, 2014
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on record review and interview, the facility failed to discharge 1 (patient #1) of 11 patients in a safe manner.

Findings include:

Review of patient #1's medical record from 10/01/13 revealed the following:
-Patient #1 had an outpatient CT (CT scan) guided celiac block/neurolysis (a procedure to block or reduce pain) on 10/01/13;
-The patient received conscious sedation (a combination of medicines to help the patient relax to block pain during a medical procedure) anesthesia;
-The procedure was completed at 1:15pm;
-Discharge instructions for celiac block/neurolysis contained the following activity restriction, "Do not drive for 24 hours after this test.";
-During recovery, the patient began to have seizure-like movements;
-The patient was transported to the facility's emergency department (ED) for further evaluation at 2:00pm;
-His work-up (labs and radiologic studies) revealed no evidence of stroke;
-The initial plan was to admit the patient for observation;
-The patient's mental status improved and the ED physician decided to discharge the patient home;
-At 10:20pm, the patient was discharged by himself to his personal vehicle and allowed to drive home.

Staff #8 reviewed the chart and confirmed the patient was discharged by himself to his personal vehicle and allowed to drive home.

During a telephone interview on 1/14/14 at 4:28pm, patient #1 reported the following:
-He was instructed to have someone available to drive him home after his procedure;
-He had a friend with him during the procedure and while he was in the ED;
-When he was told he would be admitted for observation, the friend went home and the patient's car was brought to the facility so he could drive home the following day;
-When the ED physician changed his mind, the patient was discharged by himself and allowed to drive home;
-Before leaving the facility, the patient inquired whether he should be driving and was told he could.

During an interview on 1/15/14 at 1:30pm, staff #7 reported the following:
-Patients are always instructed to bring someone to drive them home if a procedure includes conscious sedation;
-If a patient arrives without someone to drive them home, the procedure is delayed, canceled, or local anesthesia (a type of anesthesia that does not cause drowsiness and/or sedation) is used;
-The instruction for no driving for 24 hours is standard when conscious sedation is used.
VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN Tag No: A0820
Based on record review and interview, the facility failed to provide discharge instructions to 1 (patient #1) of 11 patients. Patient #1 had two invasive procedures performed (on 10/01/13 and 1/07/14) with no evidence discharge instructions were provided to the patient.

Findings include:

Review of the facility policy CS.052.1.100, "Discharge Planning," revealed the following: "Written discharge instructions are provided in a form the patient can understand and are given to the patient and/or persons responsible for providing continuing care in the Discharge Envelope."

During a telephone interview on 1/14/14 at 4:28pm, patient #1 reported the following:
-The patient did not receive discharge instructions for his CT (CT scan) guided celiac block/neurolysis (a procedure to block or reduce pain) procedure on 10/01/13;
-The patient did not receive discharge instructions for his CT guided celiac block/neurolysis procedure on 1/07/14;
-On 1/07/14, the patient asked if there were any discharge instructions for his procedure and was told there were none.

Review of patient #1's medical record for 10/01/13 revealed the following:
-Patient #1 had an outpatient CT guided celiac block/neurolysis on 10/01/13;
-The record contained a document titled, "After Visit Summary and Discharge Instructions";
-The discharge instruction document contained an area for the patient or responsible party to sign and date, indicating the discharge instructions had been received;
-The discharge instruction document contained an area for the nurse to sign and date, indicating the discharge instructions had been given to the patient or responsible party;
-There were no patient, responsible party, nor nurse signatures on the discharge instruction document;
-There was no evidence the patient received the "After Visit Summary and Discharge Instructions" document.

Review of patient #1's medical record for 1/07/14 revealed the following:
-Patient #1 had an outpatient CT guided celiac block/neurolysis on 1/07/14;
-The record contained a document titled, "After Visit Summary and Discharge Instructions";
-The discharge instruction document contained an area for the patient or responsible party to sign and date, indicating the discharge instructions had been received;
-The discharge instruction document contained an area for the nurse to sign and date, indicating the discharge instructions had been given to the patient or responsible party;
-There were no patient, responsible party, nor nurse signatures on the discharge instruction document;
-There was no evidence the patient received the "After Visit Summary and Discharge Instructions" document.