Failure to Assess and Arrange Discharge Services for Oxygen and Home Health
Penalty
Summary
The facility failed to properly assess, arrange, and document discharge services for a resident who required ongoing oxygen therapy and intravenous antibiotics after discharge. The resident, who had a history of endocarditis, enterocolitis, sepsis, emphysema, COPD, heart failure, and pulmonary hypertension, was admitted with no oxygen therapy but began using supplemental oxygen during the stay. The care plans for pneumonia and respiratory issues included oxygen therapy, but there was no documented plan of care or discharge needs assessment for home oxygen services. Upon discharge, the resident's summary indicated a continued need for 2 LPM of oxygen via nasal cannula and ongoing intravenous antibiotics. However, the electronic medical record did not contain any physician's orders or referrals for home oxygen equipment or confirmation of home health services to provide antibiotic therapy after discharge. The home health provider did not begin services until four days after the resident left the facility, resulting in missed doses of antibiotics and a lack of oxygen therapy at home during that period. Interviews with facility staff revealed that the social services assistant sent a referral for home health services to the resident's insurance provider but did not confirm receipt or authorization. The DON was unable to locate a discharge needs assessment for oxygen or documentation of a referral for home oxygen. The NHA acknowledged that the resident was discharged before confirmation that a home health provider had accepted the referral, and the physician was not notified that services were not arranged prior to discharge. The facility's discharge planning policy required identification and documentation of discharge needs, involvement of the interdisciplinary team, and confirmation of post-discharge services, all of which were not met in this case.