Preferred Hospice

“Based on medical record (MR) review, agency policy and procedure, Alabama Board of Nursing Administrative Code, and interview, it was determined the agency failed to ensure the nursing staff received the pronouncement of death via telecommunication with the physician as required by the Alabama Board of Nursing. This affected one of three records reviewed for death, including MR # 15, and had the potential to negatively affect all patients admitted to the hospice. Findings include: Agency Policy: Post-Mortem Care Policy Number: 9.31.1 Revision Date: 2014 Policy: Hospice Staff will coordinate the patients care through dying and death. Purpose: To define care coordination throughout care and post-mortem care. Procedure: ...2. ...Policies and procedures include, but are not limited to: ...Pronouncement of death according to state/federal law. Alabama Board of Nursing Administrative Code Chapter 610-X-6 Standards of Nursing Practice Revised: September 8, 2016 610-X-6-.15 Telecommunication for Pronouncement of Patient Death The licensed nurse may receive pronouncement of a patients death from a physician via telecommunication. MR # 15 was admitted to the hospice agency on 1/22/24 with the terminal diagnosis of Hypertensive Heart and Chronic Kidney Disease with Heart Failure and Stage 1- 4 Unspecified Chronic Kidney. Review of the SN (Skilled Nurse) Hospice Death Visit note dated 1/23/24 revealed the Registered Nurse (RN) documented the following in the Narrative Note, “...Patient death was pronounced by this nurse on 1/23/24 at 11:28 AM.” ...”;Primary MD (medical doctor), hospice medical director and IDG (interdisciplinary group) members were notified of death.” There was no documentation the RN received the pronouncement of death from the physician. An interview was conducted on 6/27/24 at 1:22 PM with Employee Identifier # 1, Administrator, who confirmed there was no documentation the physician made the death pronouncement.”

“Based on Medical Record (MR) review, agency policy and procedure, and interviews it was determined the agency failed to ensure staff visit notes were dated, signed, and submitted within three working days as directed in the agency’s policy. This did affect four of 19 MR’s reviewed including Home Visit (HV) # 1, MR # 8, HV # 2, MR # 6, and had the potential to negatively affect all patients plan of care services. Findings Include: Agency Policy: Timely Submission of Patient Documentation Policy Number: 11.6.1 Revised Date: 6/18 Policy: Hospice will ensure the timely and proper submission of patient documentation. Purpose: To comply with state/federal laws and regulations related to timely submission of all patient documentation. Procedure: ...2. ...all visit reports attached, must be submitted the next scheduled work day, not exceeding three (3) business days. 4. MR # 6 was admitted to the agency on 4/29/24 with the terminal diagnosis of Hypertensive Heart Disease with Heart Failure. Review of the Routine Visit notes revealed the staff failed to submit the visit reports per the agency’s policy as follows: a. Routine Visit dated 6/12/24 was signed and dated on 6/21/24, which was 7 working days late. b. Routine Visit dated 6/14/24 was signed and dated on 6/25/24, which was 7 working days late. An interview was conducted on 6/27/24 at 1:19 PM with EI # 1, who confirmed the staff failed to ensure the visit notes were dated, signed, and submitted within three working days per the agency’s policy. 3. HV # 2 was admitted to the hospice agency on 8/1/23, and recertified 5/27/24 to 7/25/24, with the terminal diagnosis of Senile Degeneration of the Brain, not otherwise specified. Review of the Routine Visit revealed the staff failed to submit the visit reports per the agency’s policy as follows: a. Routine Visit dated 6/5/24 was dated and signed on 6/21/24, which was 12 working days late. b. Routine Visit dated 6/12/24 was dated and signed on 6/21/24, which was 7 working days late. An interview was conducted on 6/27/24 at 1:00 PM with EI # 1, who confirmed the the staff failed to ensure the visit notes were dated, signed, and submitted within three working days per the agency’s policy. 1. HV # 1 was admitted to the agency on 6/7/23 and recertified from 6/1/24 to 7/30/24 with the terminal diagnosis of Respiratory Failure Unspecified, Unspecified with Hypoxia or Hypercapnia. Review of the Hospice Skilled Nurse (SN) Routine Visit notes revealed the staff failed to submit the visit reports per the agency’s policy as follows: a. Routine Visit note dated 6/3/24 was signed and dated on 6/20/24, which was 13 working days late. b. Routine Visit note dated 6/10/24 was signed and dated on 6/21/24, which was 10 working days late. An interview was conducted on 6/27/24 at 1:08 PM with Employee Identifier (EI) # 1, Administrator, who confirmed the staff failed to ensure visit notes were dated, signed, and submitted within three working days as directed in the agency’s policy. 2. MR # 8 was admitted to the agency on 4/2/24 to 6/30/24 with the terminal diagnosis of Unspecified Severe Protein Calorie Malnutrition. Review of the Hospice SN Routine Visit note dated 4/16/24 revealed the note was dated and signed on 4/29/24 which was nine working days late. An interview was conducted on 6/27/24 at 1:00 PM with Employee Identifier (EI) # 1, Administrator, who confirmed the staff failed to ensure the visit notes were dated, signed, and submitted within three working days as directed in the agency’s policy.”