HospitalInspections.org

Based on interview, record review, and policy review, it was determined the facility failed to educate and prepare 1 (Patient #1) of 3 sampled patients for post hospital care. Specifically, the facility failed to provide Patient #1's family with instructions for the care of Patient #1's external dwelling catheter (a condom catheter) and failed to make referrals for condom catheter supplies when the facility discharged Patient #1 home on 01/24/2022.

Findings included:

A review of the facility policy titled, "Discharge Planning," revised 02/23/2022, revealed, "Discharge Planning is a patient-centered, interdisciplinary process that involves the patient, caregiver(s), support person(s), authorized representative(s), physicians, hospital clinical staff, and case managers. The discharge planning process begins during the preadmission screening and continues throughout the inpatient rehabilitation stay. It is re-evaluated and adjusted as the patient's condition, functional status and clinical care needs change throughout the stay. The discharge plan is individualized and supports patient independence and self-management. The goal of the discharge planning process is to ensure an effective transition of care and reduce factors leading to preventable acute inpatient hospital readmissions." Further review of the policy revealed, "Throughout the patient's stay, the case manager works with the patient/patient representative to develop a discharge plan based on the patient's clinical care requirements, goals of care and treatment preferences, and available support network."

A review of Patient #1's "Demographic Sheet" revealed the facility admitted the patient on 01/04/2022 with diagnoses that included a spinal cord injury and stage 4 pressure ulcers to buttocks. According to the physician history and physical, the facility admitted Patient #1 from a long-term acute care hospital where the patient had been transferred for therapy following a gunshot wound.

A review of Patient #1's "Adult Admission Assessment," completed on 01/04/2022 at 10:38 PM, revealed the patient was incontinent of urine and had an external dwelling catheter

A review of a "Team Conference/Plan of Care Update," dated 01/10/2022 at 3:14 PM and 01/17/2022 at 5:42 AM, revealed Patient #1 continued to have an external dwelling catheter.

A review of the physician progress notes, dated 01/19/2022, revealed Patient #1 continued to have an external dwelling catheter.

A review of "Patient Discharge Instructions," dated 01/24/2022 at 2:30 PM, revealed Patient #1 was discharged home with plans for home health services. Further review revealed a Registered Nurse (RN) documented that medical/surgical discharge instructions were provided on 01/18/2022 at 2:19 AM. The discharge instructions for bladder management indicated "Refer to WITH notebook." Further review revealed instructions for "Spinal Cord Injury (SCI): Managing Your Bladder," that included how a SCI affected the bladder; however, there were no instructions regarding a condom catheter/external dwelling catheter. Further review of the Patient Discharge Instructions revealed the facility arranged for durable medical equipment for Patient #1; however, there were no documented instructions regarding obtaining condom catheter supplies.

A review of the physician's "Discharge Summary Rehab AA" revealed Patient #1 and their family were counseled during the hospitalization regarding the patient's discharge plan. According to the physician's summary, Patient #1 was discharged home "into the care of family member, with home health care" in stable condition. The discharge summary indicated there were no questions/concerns regarding going home and they were educated to call if home health had not arrived within 48 hours after discharge.

On 10/25/2022 at 12:50 PM, during a telephone interview, Family Member #1 stated he/she had watched one condom catheter placement at the facility but stated, "I had no idea what I was facing." Family Member #1 stated they had one condom catheter and when he/she placed the condom catheter on the patient, Patient #1 was hurting, and the family member felt a larger size was needed. However, the facility did not provide instructions on how to get condom catheter supplies, only that home health services would be there within 48 hours and would provide supplies. Family Member #1 stated he/she ended up ordering condom catheter supplies from a major internet-based company. Family Member #1 stated the hospital should have done a better job with catheter education and with information on where to get supplies.

An interview with Physician #1 on 10/24/2022 at 11:00 AM revealed when the facility admitted Patient #1, the plan was to discharge the patient home with family. According to Physician #1, the patient's family was involved in the patient's care and the treating nurse was responsible for educating the family on the condom catheter.

An interview with Licensed Practical Nurse (LPN) #1 on 10/24/2022 at 2:20 PM revealed she could not recall Patient #1; however, LPN #1 worked on the unit the night prior to the patient's discharge. LPN #1 did not recall providing education to Patient #1's family. LPN #1 stated education was normally done at discharge by the day shift nurse.

An interview conducted on 10/24/2022 at 3:00 PM with Registered Nurse (RN) #1 revealed the discharge nurse normally explained discharge instructions, which included medications, follow up appointments, and medical equipment; and answered any questions the patient might have at the time of discharge. RN #1 stated the facility did not provide supplies for patients at discharge; however, the nurse would send any leftover supplies in the patient's room that belonged to the patient. RN #1 stated she had never sent a patient home with a condom catheter but stated education should be done with the person providing care at home prior to discharge.

An interview with the Chief Nursing Officer (CNO) on 10/24/2022 at 9:45 AM revealed supplies were normally not provided or sent home with patients unless there were extra supplies left in the patient's room. The CNO stated the discharge nurse was responsible for providing discharge teaching on condom catheters. The CNO gave no explanation why the family did not receive discharge instructions on Patient #1's condom catheter and/or arrangements for supplies needed to continue the condom catheter at home.