When hospital patients are transferred to skilled nursing facilities (SNFs), medical records and discharge instructions need to go with them so that the SNF can provide proper care.  Last week’s column explained that it is easy to think that you’ve taken all the necessary steps – and still find that critical information has fallen through the cracks.

What can you do to reduce the odds that your loved one will be harmed because information is missing?

First, don’t take anything for granted.  If the discharge planner at the hospital says, “We have transferred all her records electronically,” ask them to show you on their computer exactly what records were sent. 

Second, look specifically for:  the surgeon’s description of surgery performed; lab test results; x-rays and other imaging studies, or at the very least reports describing these; results of any other tests; reports of vital signs (blood pressure, heart rate (pulse), temperature, and oxygen level in the blood); documentation of drugs given; the doctor’s observations from daily visits; nursing notes from each shift; and comments about therapies given, such as physical therapy sessions.  If anything is missing, ask how you can get it promptly.

Often, when someone tells you, “we’ve transferred all of her records,” what they mean is that they transferred all of her records “that were in that particular computer system at the time of transfer.”  They may have multiple computer systems; it may take time for some information to get entered into that system; and some information may never be captured there.

Third, understand that the above are termed “medical records.”  If you ask only for “discharge instructions,” they will typically not include any of the above information.

Fourth, when given discharge instructions, check to make sure that the drugs listed are the ones you are expecting to see, and that drugs the patient was on before going to the hospital are accounted for – either to be continued or to be discontinued.  Also check to make sure that notes include the date and time when the latest dose of each current drug was given. 

Fifth, after confirming that the nurse called the SNF with the latest information, call the SNF yourself and ask if they have the information they need. Doing so will serve to check that the information made it to the right person.

Sixth, when the surgeon or hospitalist tells you anything at all about what is supposed to happen after your relative is discharged, ask, “Is that in writing in the discharge instructions?”  Be a broken record:  “Is that in writing?  Is that in writing?”

By taking these steps, you can help ensure that the skilled nursing facility has the information it needs to take proper care of your relative.