Resident Discharged Without Physician Order or Safe Discharge Planning
Penalty
Summary
A deficiency occurred when a resident was discharged home without a physician's knowledge, order, or consent. The resident had a recent history of right ankle trimalleolar fracture with open reduction internal fixation (ORIF), was non-weight bearing, and required partial to moderate assistance with ambulation and transfers. The care plan identified risks for falls and orthopedic complications but did not address discharge planning or the resident's preferences regarding discharge. There was no documentation in the care plan or progress notes indicating that the resident had expressed a desire to leave the facility or that discharge planning had been discussed with her. On the day of discharge, conflicting information was provided to the resident and her family regarding whether she could be released, with staff initially stating she could go home, then later retracting this due to the absence of a physician's order, and finally stating she could be discharged. The resident was ultimately discharged with the assistance of a friend, who provided care at home, including help with mobility, wound care, and daily activities. Occupational therapy had recommended continued stay in the facility due to environmental barriers at home and the need for physical assistance with stairs, and the primary physician had explicitly stated that discharge was not safe due to ongoing therapy needs and uncertainty about the resident's support system at home. Interviews with facility staff revealed that a new RN was instructed to obtain a discharge order but did not actually secure one from the physician. The Social Service Director believed an order had been obtained, and home health services were arranged, but the discharge proceeded without proper physician authorization. The primary physician later confirmed that he had denied the discharge request due to safety concerns, and the Medical Director stated he would not have approved discharge against therapy recommendations or the primary physician's wishes. The facility's discharge policy requires physician authorization and appropriate planning, which was not followed in this case.