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.
|PIKEVILLE MEDICAL CENTER||911 BYPASS ROAD PIKEVILLE, KY 41501||April 24, 2019|
|VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN||Tag No: A0820|
|Based on record review, interview, and review of facility policies/procedures, it was determined the facility failed to ensure one (1) of ten (10) sampled patients and the patient's family were counseled to prepare them for post-hospital care.
The findings include:
Review of the Discharge Planning Policy, not dated, revealed "at a minimum, the discharge planning process is initiated at the time of admission" and all disciplines were involved in the discharge planning process. The policy stated discharge rounds were performed daily to review each patient's hospital course and need for discharge planning. Further review of the policy revealed patient education was a major focus of discharge planning activities, as many aftercare needs were met through education provided by the multi-disciplinary team.
Review of the facility's Discharge Planning Checklist that is "Not part of the patient record" revealed on the day prior to discharge the facility should notify the patient's family of the anticipated discharge date /time to pick up the patient, verify wound care education was completed, educate on home medications, and ensure home equipment/therapy is ready for discharge. Further review revealed on the day of discharge the facility should print discharge instructions, medication information sheets, and discharge instructions for all patient conditions and home care needs.
Review of the "DISCHARGE PROCESS FOR AN INPATIENT," not dated, revealed the nurse and a second nurse were required to perform and document a "Discharge Time-Out" to verify that all discharge instructions/information matches the patient's arm band. Further review revealed the nurse should give the patient's discharge care instructions and discharge summary upon discharge, verify the patient's understanding of the information, and obtain a signature. In addition, the process revealed the nurse should provide "hand off communication" to Emergency Medical Services (EMS) staff if an ambulance is utilized. Continued review revealed staff should document the discharge position in the patient's medical record.
Medical record review revealed the facility admitted Patient #2 on 03/29/19 with diagnoses that included cellulitis/abscess of the buttock. Patient #2 underwent an incision and drainage of the abscess on 03/29/19. According to the medical record, Patient #2 was alert, oriented, and declined nursing facility rehabilitation. Further review revealed the patient was discharged home on 04/01/19 with home health services.
Review of the facility incident report dated 04/02/19 revealed Patient #2's family filed a grievance related to the patient's discharge. According to the complainant, Patient #2 was discharged to the wrong address and no one notified the family of the patient's discharge. Further review of the incident report revealed Patient #2 was discharged home with no prescriptions, no follow-up appointments, and with arrangements for the facility's home health agency to provide physical therapy services without providing the family with options for home health services.
On 04/23/19 at 11:45 AM, an interview was conducted with the surgeon who provided care for Patient #2. The surgeon stated on the morning of 04/01/19 he ordered the patient's discharge, wrote a prescription for an antibiotic, and instructed the patient to follow up with their local surgeon. The surgeon stated the patient's family was at the patient's bedside when discharge instructions were discussed.
A telephone interview conducted with Registered Nurse (RN) #1 on 04/23/19 at 11:00 AM revealed she provided care for Patient #2 on 04/01/19, when the patient was discharged home. RN #1 stated the facility's social worker normally called a patient's family to arrange discharge. However, after Patient #2 had been discharged home, the social worker told RN #1 that she had not contacted Patient #2's family prior to discharge because the wrong phone number was listed on the patient's medical record. According to RN #1, Patient #2's family had previously given staff the correct phone numbers; however, the correct phone numbers were not placed in the patient's medical record. Further interview with RN #1 revealed she completed the patient's discharge paperwork; however, after EMS left with the patient she found the discharge paperwork and the patient's prescription in the patient's room on the bedside table. Continued interview with RN #1 revealed she called the patient's antibiotic prescription to a pharmacy the following morning because the pharmacy was closed when she discovered the prescription/discharge paperwork had been left behind. However, further interview with the RN revealed she did not notify Patient #2's family that the discharge instruction/prescription had been left at the facility.
An interview with the Social Worker on 04/23/19 at 1:00 PM revealed she discussed Patient #2's discharge with the patient and completed the discharge paperwork. The Social Worker stated she did not notify the patient's family of the patient's discharge plan nor when she became aware that the patient's discharge instructions had been left behind. According to the Social Worker, nursing staff were required to notify a patient's family of the discharge plan.
Interview with a facility Risk Manager on 04/23/19 at 11:00 AM revealed Patient #2 was transported to the wrong address upon discharge from the facility. She stated the facility determined that the Registration Clerk put the wrong address on the patient's medical record. The Risk Manager confirmed that EMS forgot the patient's discharge instructions/prescription in the patient's room. The Risk Manager gave no explanation why the family was not notified that the documents were left behind and/or gave the patient further instructions.