Faith Hospice

“Observed in Record Review. In 14 of 14 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, RRHV#2, “Patient will continue to maintain edema or show decreased edema in 2 weeks and while on hospice services.” There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Finding was verified with the Director of Clinical Services, the Regional Director of Operations, and the QAPI Director.”

“Observed in Record Review. In 5 of 14 patient records reviewed, for active patients it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#1, RRHV#3, and RRNHV#6 the oxygen orders were for Oxygen 2 to 4 liters per minute binasal cannula as needed. Orders did not include parameters for titration or where the liter flow was to start. For RRNHV#1, the oxygen dosage orders were for 3.5 liters oxygen per minute continuously but it did not indicate the route, the instructions were 2-4 liters per minute via nasal canula continuously. Additionally, RRHV#3, the patient had two medications for pain (Acetaminophen and Hydrocodone APAP), but the orders did not indicate when to take which pain medication. RRNHV#1 the patient had four medications ordered for inhalation therapy, only two of the medication orders indicated that they were to be administered via the nebulizer. For RRNHV#4, the patient had two pain medications, Acetaminophen 325mg, 2 tabs every four hours for pain and Oxycodone HCl 5mg tab ordered both for pain with no indication of when to take which one. Findings were discussed with the Director of Clinical Services and the Regional Director of Operations. it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#1, RRHV#3, and RRNHV#6 the oxygen orders were for Oxygen 2 to 4 liters per minute binasal cannula as needed. Orders did not include parameters for titration or where the liter flow was to start. For RRNHV#1, the oxygen dosage orders were for 3.5 liters oxygen per minute continuously but it did not indicate the route, the instructions were 2-4 liters per minute via nasal canula continuously. Additionally, RRHV#3, the patient had two medications for pain (Acetaminophen and Hydrocodone APAP), but the orders did not indicate when to take which pain medication. RRNHV#1 the patient had four medications ordered for inhalation therapy, only two of the medication orders indicated that they were to be administered via the nebulizer. For RRNHV#4, the patient had two pain medications, Acetaminophen 325mg, 2 tabs every four hours for pain and Oxycodone HCl 5mg tab ordered both for pain with no indication of when to take which one. Findings were discussed with the Director of Clinical Services and the Regional Director of Operations.”

“Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During RRHV#4, the registered nurse, hand sanitized, then set up his barriers, nursing bag and equipment, then gloved without hand sanitizing. He doffed and donned gloves during the visit another time without hand sanitizing and went in and out of his bag several times with his dirty gloves on to get alcohol wipes to clean his equipment. The patient had an abscess on his rectum that was draining with visible soiled linens and pillows all around the patient’s bedroom. Findings were discussed with the nurse on site and then later with the Clinical Director who had been present on the visit.”

“Observed in Record Review. In 4 of 13 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plan did not contain all the necessary or current information. The organization’s EMR used a “task list” to assign duties to the hospice to provide care to the patient. For RRHV#1, RRHV#3, and RRNHV#1 the patient had continuous oxygen yet the “task list” did not include any mention of the oxygen or what the aide should do with it during the patient’s shower. For RRNHV#4, the patient had a feeding tube and wounds with no instruction as to what the aide should do. Additionally, there were no instructions as to when the hospice aide should notify the nurse Findings were discussed with the Director of Clinical Services and”