Failure to Provide Timely Discharge Medications and Notification to Social Security
Penalty
Summary
The facility failed to ensure a resident received timely access to prescribed medications upon discharge and did not provide timely notification to Social Security (SS) regarding the resident's discharge. The resident, who had multiple diagnoses including frontotemporal neurocognitive disorder, diabetes, hypertension, and multiple myeloma, was discharged to his home with a three-day supply of medication. However, the prescriptions for ongoing medications were not sent to the external pharmacy until eight days after discharge, resulting in a delay in the resident receiving his medications. Staff interviews confirmed that the discharge prescriptions were not sent as intended, and there was no confirmation of the prescriptions being faxed on the day of discharge. Additionally, the facility did not notify SS of the resident's discharge in a timely manner. The Business Office Manager (BOM) acknowledged that notification to SS was delayed by 13 days due to issues with the fax machine and lack of access to alternative faxing methods. The BOM also stated that there was no written policy regarding the timeframe for SS notification at the time of the incident, and that previous guidance allowed for up to 30 days, which was later changed to three days by the corporate office. The deficiency was identified through review of the electronic medical record, external pharmacy records, staff and family interviews, and facility policy. The resident involved was cognitively intact at the time of discharge, and interviews with the resident and his son indicated that no physical or psychosocial harm resulted from the delay in medication. The facility's discharge summary policy required reconciliation of all pre- and post-discharge medications, but this process was not completed in a timely manner for this resident.