Coosa Valley Hospice

“Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that are specific, measurable, and time-bound. In review of RRHV#2 there were goals noted in the plan of care that were not specific and measurable. For example, a spiritual goal read In previous visits, pt has been hesitant to talk about spiritual matters. Chaplain will focus the next month on determining what level of spiritual interest she has and Chaplain will continue to explore pt’s level of interest in spiritual matters. In RRHV#3 a psychosocial goal read like an intervention as it read Linkage /advocacy/ referral to community resources as needed including meals on wheels/ frozen meals services. An example in RRNHV#5 an example of a non measurable goals were Patient/caregiver will demonstrate improved nutritional status with in the next month and Patient’s symptoms will be consistent with stage of disease process and problems managed as well as disease process will allow during this certification period. These observations were reviewed with the Hospice Director and Clinical Manager.”

“Observed in Record Review. In 6 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#3 the patient was ordered CPAP yet the device and its use was not reflected on the plan of care. In RRNHV#4 the documentation noted the patient with difficulty swallowing and also had blood glucose monitoring that were not reflected on the plan of care. In RRNHV#6 the patient had a wound to the buttocks/sacrum yet the plan of care for skin integrity was not specific to the wound and did not guide the care. In RRNHV#7 and RRNHV#10 the patients were diabetic with insulin and blood glucose monitoring yet there was no care plan to guide the care. In RRNHV#8 there was a goal that specified Patient /caregiver will verbalize understanding of falls/injury prevention and home safety measures within the next month yet the only intervention was to assess for fall risk and did not address educating the patient/caregiver on fall/injury prevention to achieve the goal. These observations were reviewed with the Hospice Director and the Clinical Manager.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. On review of RRNHV#4 the patient had a skin tear with orders for wound treatment yet the order lacked a frequency and who was to perform the care. There was also an order for blood glucose monitoring yet the order did not specify who was to perform the monitoring. In RRNHV#10 there was an order for insulin to be given as needed if blood glucose was greater than 150, however there were no physicians order for blood glucose monitoring. These observations were reviewed with the Hospice Director and the Clinical Manager.”

“Observed in Record Review. In 2 of 8 patient records reviewed, with hospice aide services, the organization failed to ensure the registered nurse prepare written patient care instructions for the hospice aide. On review of RRNHV#6 the patient had orders for wound treatments to heels and wound dressing to the sacrum yet there were no specific instructions for the aide to know how to handle the areas while providing care. In RRNHV#7 the patient was on Eliquis, Xarelto, and Aspirin but the aide plan of care did not instruct the aide that the patient was on bleeding precautions. This observation was reviewed with the Hospice Director and Clinical Manager.”

“Observed in Patient Home. In 1 of 1 home visits conducted, where medication reconciliation was performed, the organization failed to ensure the patient record reflect the patient’s care, treatment, and services. On home observation of medication reconciliation for RRHV#1 the skilled nursing facility medication profile noted the patient was prescribed Antacid liquid as needed for gastric (GI) distress, and the facility offered the patient Mylanta during the visit, yet the Antacid liquid was not a part of the hospice plan of care. The medication order per the facility was dated for February. This observation was reviewed with the RN, Clinical Manager, and Administrator.”

“Observed in Record Review. In 2 of 3 patient records reviewed, for active patient records cared for in a Skilled Nursing Facility, the organization failed to ensure the hospice plan of care identify the care and services needed and specifically identify which provider is responsible for performing the respective functions. On review of RRHV#1 the patient resided in a Skilled Nursing Facility (SNF) and was receiving wound care treatments, and blood glucose monitoring yet the plan of care did not indicate who was to perform the care included in the plan of care. In RRNHV#4 the SNF patient had orders for a skin tear with wound care, and blood glucose monitoring yet there was no delegation of who was to perform the tasks in the plan of care. This observation was reviewed with the Hospice Director, and Clinical Manager.”