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JACKSON PARK HOSPITAL 7531 S STONY ISLAND AVE CHICAGO, IL 60649 Oct. 16, 2020
VIOLATION: DISCHARGE PLANNING - PT RE-EVALUATION Tag No: A0802
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on document review and interview, it was determined that for 1 of 10 patients' (Pt. #1) clinical records reviewed for discharge planning, the Hospital failed to re-evaluate the patient's needs, to ensure modification in discharge placement was safe.

Findings include:

1. On 10/15/2020, the clinical record of Pt. #1 was reviewed. Pt. #1 was admitted on [DATE] with a diagnosis of schizophrenia (mental disorder). Pt. #1 with a previous history of residence of a nursing home due to chronic mental illness. The clinical record included:

- MD #2's (attending psychiatrist) progress note dated 9/9/2020 at 8:41 AM included, " ...Disposition: (Pt. #1) would like to go to a different nursing home. Will facilitate across everything and transfer to a nursing home ... Anticipated discharge date : 9/14/2020 ..."

- The mental health worker's progress note dated 9/13/2020 at 6:37 PM included, " ... (Pt. #1) has a POA (power of attorney) ... wants (Pt. #1) to return to (Facility A) ..."

- MD #2's discharge summary dated 9/14/2020 at 8:59 AM included, " ... (Pt. #1) is doing better. ... Disposition: The patient would like to go to a different nursing home. Will facilitate across everything and transfer to a nursing home ... Condition at time of discharge ... (Pt. #1) is relatively stable ..."

- E #3's (mental health worker) progress note dated 9/14/2020 included, " ... (Pt. #1) will be discharged to (Facility B/shelter) ... (Pt. #1) refused all placement offered by the Hospital ... (Pt. #1) has no suicidal thoughts mood is stable for (discharge) ..."

- E # 10's (registered nurse) progress note dated 9/14/2020 at 6:21 PM, "(Pt. #1) had his lunch, was discharged ... picked up by family member (sister), left with medication supply and discharge papers ..." The discharge instructions signed by Pt. #1 indicated that Pt. #1 was discharged to home.

- The clinical record did not include a re-evaluation of the Pt. #1's condition and needs, to ensure that the change in the patient's discharge placement was safe.

2. The Hospital's policy titled, "Behavioral Medicine Discharge Planning and Continuity of Care" (revised 1/2020) included, "Discharge planning is the process that prepares a patient in a hospital setting for a safe return or re-entry into the community ... includes the patient and or their family ... the patient's physician and other members of the treatment team, the Nurse and the Mental Health Workers ..." The policy did not include the process of re-evaluating change in patient's needs to ensure appropriate placement.

3. On 10/15/2020, at approximately 3:00 PM, an interview was conducted with MD #2 (attending psychiatrist). MD #2 clarified that the discharge order that he (MD #2) signed for Pt. #1 on 9/14/2020 was for Pt. #1 to be discharged to the nursing home. MD #2 said that he (MD #2) expected to be notified if Pt. #1 refused discharge placements, to re-evaluate Pt. #1's needs. MD #2 could not recall if the staff informed him (MD #2) of Pt. #1's discharge placement refusal.

4. On 10/15/2020, at approximately 3:40 PM, an interview was conducted with E #3 (mental health counselor/discharge planner). E #3 stated that he did not document that MD #2 was notified of the patient's refusal for discharge placement.

5. On 10/15/2020, at approximately 4:09 PM, an interview was conducted with E #10 (registered nurse). E #10 stated, "(MD #2) ordered (Pt. #1) to be discharged home ... I did not know that there was a need to discharge (Pt. #1) to a nursing home ... (Pt. #1's) sister came and picked up the patient ..."

6. On 10/16/2020 at approximately 10:30 AM, findings were discussed with E #2 (Senior Program Manager, Behavioral Health Medicine). E #2 said that to indicate that a re-evaluation of the patient's condition was conducted, there should have been at least a documentation that the psychiatrist was notified of the change in the discharge plan. E #2 could not provide documentation for the findings.
VIOLATION: POST-HOSPITAL SERVICES Tag No: A0808
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on document review and interview, it was determined that for 1 of 10 patients' (Pt. #1) clinical records reviewed for discharge planning, the Hospital failed to ensure that the discharge plan was discussed with the patient and/or patient representative.

Findings include:

1. On 10/15/2020, the clinical record of Pt. #1 was reviewed. Pt. #1 was admitted on [DATE] due to violent and aggressive behavior. The clinical record included:

-E #5's (mental health worker) progress notes dated 8/28/2020 at 12:41 PM included, " ... Presenting Problem ... (Pt. #1) ... brought to the ER from (nursing home due to) violent, aggressive behavior towards staff and residents ... (Pt. #1) does not want to return to (Facility A/nursing home), requesting a new nursing home ..."

-The mental health worker progress note dated 8/30/2020 at 4:08 PM included, " ... the discharge plan (evaluation) remains the same to return to (Facility A) ... "

-MD #1's (attending psychiatrist) discharge summary dated 9/1/2020 included, " ... Discharge Plan (evaluation) ... (Pt. #1) ... discharge to shelter ..."

-E# 4's (registered nurse) progress notes dated 9/1/2020 included, "(Pt. #1 alert, oriented to name, time, and place)... discharge instructions explained ..." The discharge instructions indicated that Pt. #1 was discharged to (Facility B/shelter).

- The clinical record lacked documentation that the evaluation and plans to discharge Pt. #1 to the shelter was discussed and accepted by Pt. #1.

2. On 10/15/2020, the Hospital's policy titled "Behavioral Medicine Discharge Planning and Continuity of Care" (revised 1/2020) included, " ... Discharge planning is the process that prepares a patient in a hospital setting for a safe return or re-entry into the community ... 1. The Nurse (RN) and Mental Health Worker (MHW) assigned to the patient will document, the patient, family and physician's acceptance of the discharge plan of care ..."

3. On 10/16/2020 at approximately 10:15 AM, a telephone interview was conducted with E #4 (registered nurse). E #4 stated that discussion and acceptance of the discharge plan by the patient is done by the physician and the mental health worker.

4. On 10/16/2020, at approximately 10:30 AM, findings were discussed with E #2 (Senior Program Manager, Behavioral Health Medicine). E #2 stated that she (E #2) is a licensed social worker and has the oversight for the mental health workers discharge planning. E #2 stated that there should be a documentation that the discharge plan was reviewed and accepted by the patient. E #2 could not provide documentation for the findings.