Failure to Schedule and Complete Urology Follow-Up After Hospital Discharge
Penalty
Summary
The facility failed to ensure that a hospital physician's discharge order for a follow-up appointment with urology was scheduled and completed for a resident who was readmitted from the hospital. Upon re-entry, the resident had a history of severely impaired cognition, impaired mobility, neurogenic bladder, renal failure, diabetes mellitus, and was dependent on an indwelling urinary catheter. Hospital discharge instructions specifically directed that the Foley catheter was to remain in place until a follow-up with urology, and that the catheter should be changed every four weeks. However, review of the resident's medical records did not identify that a urology appointment was scheduled or completed as ordered. Progress notes and interviews revealed ongoing complications with the resident's urinary catheter, including episodes of no urine output, unsuccessful irrigation, bleeding at the catheter insertion site, and eventual trauma during catheter removal that resulted in an emergency room visit and hospital admission for catheter complications and UTI. The hospital discharge summary after this event noted a fissure caused by the catheter and provided specific instructions for catheter care, including a referral to urology for possible supra-pubic catheter placement. Despite these ongoing issues, staff interviews confirmed that the resident had not been scheduled for a urology appointment after the initial hospital discharge, and the last known urology visit was several years prior. Multiple staff members, including the assistant director of nursing and the director of nursing, acknowledged that the follow-up with urology was not completed and that the facility did not ensure the appointment was scheduled as ordered. Family members also expressed concern and were unaware of any urology follow-up. The deficiency was attributed to a lack of follow-through on discharge orders and inadequate documentation and communication regarding specialist appointments.