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Based on record review and interviews with Patient Identifer (PI) #1's designated family member, it was determined that hospital staff failed to inform PI #1's designated family member when the patient experienced a six pound weight loss on 3/21/2011, inform the family when the physician ordered PI #1's diet changed on 4/7/201, and failed to notify the designated family member when PI #1 was discharged and admitted to a skilled nursing facility (SNF) / nursing home on 4/8/11.
This deficient practice effected PI# 1, one of eleven sampled patients.

Findings Include:

On 3/11/2011, PI# 1 was admitted to the hospital with a documented weight of 185 pounds (on the admission assessment sheet).
On 3/17/2011, staff documented (on the graphic sheet) that PI # 1 stood on the scale and the recorded weight was 182 pounds.
On 3/21/11 at 16:30, staff documented a Nutrition F/U (follow-up) note that included: Wt (weight): 182# (pounds) (a decrease 3 # since admission) 1.6 % decrease in wt. Intake usually good. Diet mech (mechanical) soft 50-199% intake. 0 (no) new labs at present. Cont (continue) current diet and encourage intake of meals and fluids. Will monitor and F/U 5 - 7 days.
On 3/28/2011, staff documented (on the graphic sheet) that PI #1's weight was 179 pounds.
On 3/28/11 at 16:00, staff documented Nutrition F/U: Wt: 179# (3# decrease...). There was no documentation included in the Nutrition F/U notes or Nursing Notes that the designated family was informed of PI #1's weight loss.

On 4/6/11 at 10:25, the Discharge Planning / Social Services notes include:
Discharge Planning / Social Services...Spoke w (with) (designated family member) and explained that she will have to complete paperwork at NH (nursing home) b/4 (before) (designated family member) leaves on vacation b/c (because) if he (PI #1) no longer meets criteria for our program than (designated family member) is at risk of having to pay out of pocket for the days he (PI #1) stays here. (Designated family member) stated (designated family member) would complete the paperwork b/4 leaving on vacation and asked to be notified once he (PI #1) is discharged.

On 4/7/11 at 08:00, the Patient's Progress Notes record that PI # 1 had "...difficulty chewing his food...A/P (assessment / plan): Dehydration - encourage po fluids. (Change) to pureed diet..."

The 4/7/11 Physician's Orders include an order to change PI #1's diet to a Pureed Diet and direct staff to encourage po (oral) fluids. There was no documentation in the Nursing Notes indicating staff notified PI# 1's designated family member of these changes in PI #1's nutritional status or diet.

On 4/8/11, the day of PI# 1's discharge, the following documentation was recorded in the Nurses Notes:
08:00 Alert c (with) confusion. Speaks occasionally. Flat affect, poor appetite. 0 aggressive behavior or agitation at present.
1200 Rescue Squad present to transport pt (patient) to Nursing Home with pt discharged at this time.
12:25 Report to (name of person) at Nursing Home.
There was no documentation to revealed the staff notified PI #1's designated family of PI #1 discharge and transfer from the hospital and admission to the SNF/nursing home on 4/8/11.

On 4/20/11 at 10:45 AM, the Social Worker, identified as Employee Identifier #1, was interviewed and said;
"On day 26 (4-6-11) exactly, (designated family member) called saying 'I'm going on vacation... The least you can do is keep him (PI #1) until Tuesday (4-12-11). I said 'Let me speak with my supervisor.' I spoke with (EI #2, Unit Manager) about letting (PI #1) stay until Tuesday. (EI #2) said that they (designated family member) need to understand that they (designated family member) may incur the cost of him (PI #1) staying extra days if he (PI #1) meets discharge criteria (discharge on Friday, 4-8-11). Medicare won't pay for him (PI #1) to stay here. I called (designated family member) back and explained to (designated family member) what (EI #2) told me... I explained that he (PI #1) is at his baseline, that his behavior has improved, not hitting staff... If his behavior stays the same and continues to improve he (PI #1) will be discharged this Friday (SNF had already accepted PI #1)... The SNF called me on 4-7-11, Thursday and told me that (designated family member) had come by and completed the paper work... They (SNF) asked me what time Friday where we discharging (PI #1). I had not called (SNF) to tell them when we were discharging (PI #1) so that meant that (designated family member) had told the nursing home that we were discharging (PI #1) on Friday (4-8-11). I did tell (designated family member) that once I got all the paperwork done and arranged that I would call (designated family member) again (second call)... I did not call (designated family member) a second time. I take full responsibility... But I did tell (designated family member) that we were looking for him (PI #1) to go to (SNF) on Friday (4-8-11), that he (PI #1) would go by EMS (emergency medical service), and that all of his (PI #1) belongings would be sent with him."

On 4-20-11 at 3:00 PM, the Unit Manage, Employee Identifier #2 (EI #2), was interviewed and stated; "They (designated family member) did request that (PI #1) be kept over the weekend because they had plans for the weekend... We didn't refuse to keep the (PI #1) over the weekend if that's what they (family)wanted but they might get a bill for it... The discharging nurse (EI #3) did neglect to give the family a courtesy call that the patient was being discharged and transferred to the nursing home (4-8-11). (EI #3) said that she thought (EI #1) Social Worker had called and told the (designated family member) about the discharge and forgot to call the family on the day of discharge. (EI #1, Social Worker) told the (designated family member)that there was a chance he (PI #1) could be discharged on Friday (4/8/11). The nurses give the family a courtesy call before the patient is discharged."

This citation is written as a result of the investigation of complaint AL00024178.

Based on medical record review and interviews, the hospital staff failed to update Patient Identifier (PI) # 1's plan of care, after the patient had a documented weight loss, a decrease appetite, and a decrease oral fluid intake.
This deficient practice effected PI# 1, one of eleven sampled patients.

Findings Include:

PI# 1 was admitted on 2/11/11 with a documented weight of 185 pounds (on the admission assessment sheet).
On 3/17/2011, staff documented, on the graphic sheet that PI # 1 stood on the scale and the recorded weight was 182 pounds.
On 3/21/11 at 16:30, the Nutrition F/U (follow-up) notes include:
Wt (weight): 182# (pound) (decrease 3# since admission) 1.6% decrease in wt. Intake usually good. Diet mech soft 50-199% intake. 0 (no) new labs at present. Cont (continue) current diet and encourage intake of meals and fluids. Will monitor and F/U 5-7 days.
On 3/28/2011, staff documented PI #1's weight was 179 pounds (on the graphic sheet).
On 3/28/11 at 16:00, staff documented Nutrition F/U: Wt: 179# (3# decrease...).
On 4/7/11 at 08:00, documentation in the Patient's Progress Notes reveal that PI# 1 had "...difficulty chewing his food...A/P (assessment / plan): Dehydration - encourage po fluids. (Change) to pureed diet..."
The 4/7/11 Physician's Orders included an order to change PI #1's diet to a Pureed Diet and direct staff to encourage po (oral) fluids.

The Ongoing Nursing Care plan recorded the PI #1's diet, and staff checked a space to indicate the amount of oral intake at each meal, and or the patient's refusal of a meal or liquids. The plan of care did not address PI# 1's identified weight loss, decreased liquid intake, or specific interventions to increase PI# 1's oral intake or prevent further weight loss.

This citation is written as a result of the investigation of complaint AL00024178.