| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 530033 | (X3) Date Survey Completed 10/23/2013 |
| Name of Provider or Supplier Mountain View Regional Hospital | Street Address, City, State 6550 East 2nd Street, Casper, WY | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| A0821 | REASSESSMENT OF A DISCHARGE PLAN CFR(s): 482.43(c)(4) The hospital must reassess the patient's discharge plan if there are factors that may affect continuing care needs or the appropriateness of the discharge plan. This STANDARD is not met as evidenced by: Based on staff interview, medical record review, and review of the nursing facility death records, the hospital failed to ensure effective discharge planning needs were implemented for 1 of 7 sample patients (#3). The findings were: Review of the medical record showed patient #3 was admitted on 5/21/13 with diagnoses including lumbar spinal stenosis, lumbar radiculopathy, lumbar spondylosis, and neurogenic claudication. Review of the 5/21/13 operative report showed the patient had a complete L4 decompressive lumbar laminectomy with bilateral open facet rhizotomies, medial facetectomies, and foraminotomies performed. On 5/25/13 the patient had an unplanned additional surgical procedure which included exploration of the lumbar wound and L3 decompression with L2-L3 diskectomy. Review of the 5/21/13 multidisciplinary discharge planning form showed resident #3 was independent and alert. Further review showed "No needs voiced @ this time." However, review of the medical record showed the patient had an unplanned second surgical procedure on 5/25/13, had a decline in physical mobility after the second surgery, and had significant issues with constipation. The following concerns with discharge planning were identified: a. Review of the physical therapy progress notes dated 5/28/13 (day of discharge) and timed at 9:25 AM (approximately 1 hour prior to discharge) showed the patient required increased assistance for all mobility that morning. The patient leaned to the left throughout the entire treatment and required maximum assistance of two to manage his/her walker and to stand upright without leaning to the left. All transfers required maximum assistance. Review of the medical record showed the resident had previously been independent with ambulation and mobility. There was no evidence in the medical record that the patient's discharge planning needs were re-assessed after the second surgical procedure was performed and his/her change in condition. b. The patient was discharged to a nursing home on 5/28/13 at 10:23 AM without having had a BM for 7 days and had experienced bloating, nausea, abdominal distention and firmness significant enough to make it impossible for the physical therapist to place the lumbar brace on the patient that morning. There was no evidence in the medical record that the patient's discharge planning needs were re-assessed after his/her change in condition. c. During an interview with the 2 case managers on 10/23/13 at 10:05 AM, they both acknowledged their had been recent issues with the discharge planning process and changes were made. They acknowledged some of the patient needs were missed or not addressed adequately, including this patient. d. Review of the nursing facility death records showed the patient was lethargic upon admission, his/her abdomen was distended and tender, and s/he was found dead at 4:20 AM on the morning of 5/29/13, less than 24 hours after transfer from the hospital. |