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.

Based on clinical record review, staff interview, and during a complaint investigation, it was determined the facility staff failed to ensure an appropriate discharge plan included setting-up durable medical equipment (DME) during discharge for one (1) of three (3) patients within the survey sample (Patient #1).

The findings were:

Staff Member #6 documented a Virginia Uniform Assessment Instrument (UAI) for Patient #1 (a form used to determine the care and eligibility needs of an individual). On 07/20/20, Staff Member #6 writes under "Functional Status" section that Patient #1 requires both mechanical help (MH) and human help (HH) for the following activities of daily living (ADLs): bathing, dressing, toileting, transferring, eating/feeding, mobility, and wheeling. Staff Member #6 continues to say that Patient #1 has ongoing medical/nursing needs related to evidence of medical instability, need for observation and assessment to prevent destabilization, as well as a complexity created by multiple medical conditions. Staff Member #6 writes, "[Patient #1] is dependent on all ADLs and IADL's after recent amputation, also continues with AMS [altered mental status] along with comorbidities."

On 07/21/20 at 11:34 am, Staff Member #11 (Occupational Therapist) documents on assessment that Patient #1 was "minimally mobile, received help with ADLs ...seems minimally cognitively intact and oriented". Staff Member #11 writes, "IF patient discharges home will need the following DME: AE: long handled bathing, AE: long handled dressing, bedside commode, gait belt, hospital bed, mechanical lift, transfer bench, and wheelchair."

The surveyor interviewed Staff Member #12 on 10/30/20 at 2:10 pm. Staff Member #12 stated that any DME needed for a patient is the responsibility of the hospital personnel prior to discharge. Staff Member #12 added that an order for DME must be made by a provider in order to begin the process of DME acquisition prior to the patient's discharge.

The surveyor confirmed there were no orders for any DME for Patient #1 during discharge of second hospitalization . The surveyor interviewed Staff Member #11 on 11/02/20 at 3:30 pm. Staff Member #11 stated in order for DME to be given to a patient, an order must be placed, and a referral should be made. Staff Member #11 added that a brochure related to additional resources for assistance in acquiring needed DME is available when needed. Both Staff Member #11 and Staff Member #8 stated that all interventions relating to the above should be documented in the medical record.

Staff interview and documentation review confirm no DME was ordered for the patient following discharge, and there was no evidence showing any attempts were made to educate, arrange or consult other agencies for DME