Savior Hospice

“Observed in Record Review. In 2 of 19 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RRNHV#1, the patient was admitted with metastatic cancer with pain management as an active problem. The pain management goal did not include an appropriately time based goal for the patient for whom the current pain on admission was a 6 and the goal was a 0. The goal read Patient will have pain controlled to patient’s satisfaction during this certification period. In the chart for RRNHV#2, there was no goal related to understanding of oxygen safety risks on the plan of care; the fall reduction goal timeframe was not targeted to the patient’s understanding of the fall risk reduction teaching or implementation of the recommended risk reduction interventions, rather that the patient would not fall during the certification period. This was discussed with the Administrator and Nursing supervisors. Observed in Record Review. In 4 of 19 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RRHV#1, the goals were not measurable and time based, including Patient will achieve and maintain optimal physical comfort. No time frame was included in the goal. In the chart for RRHV#2, an example was, Patient will achieve optimal breathing patterns to his/her desired level of comfort during this certification period. In the chart for RRHV#4, the music therapy goals are not included on the hospice plan of care. In the chart for RRNHV#10, there was no goal on plan of care related to the patient or caregiver’s ability to perform the tube feedings nor care to the g-tube site. There was also a goal on the plan of care which was not individualized to this NPO patient, Patient will pass food and fluid from mouth to stomach safely during these certification period. This was discussed with the Administrator and Nursing supervisors. Observed in Record Review. In 1 of 19 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings and services required to meet those goals. In the chart for RRNHV#5, there was no goal on POC related to understanding of oxygen safety recommendations; the patient is a smoker. This was discussed with the Executive Director.”

“Observed in Record Review. In 1 of 19 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions including treatments necessary to meet the patient’s needs. In the chart for RRNHV#2, the plan of care did not include the wound care orders nor any individualized fall prevention interventions, rather a generic intervention to instruct on individualized fall prevention techniques. This was discussed with the Administrator and Nurses assisting with record review. Observed in Record Review. In 2 of 19 patient records reviewed, the plan of care did not include all treatments necessary to meet the patient’s needs. In the chart for RRHV#4, the Oxygen order was not on the current plan of care, nor are the music therapy interventions. In the chart for RRNHV#10, there were multiple medications (Norvasc, Lactulose, K-Phos, etc.) which were listed as oral on the plan of care for the patient who was NPO with a g-tube upon readmission to the hospice. The nutritional interventions on the plan of care were not patient specific for this NPO patient as they included adding thickener to the patient’s feedings. This was discussed with the Executive Director.”

“Observed in Record Review. In 1 of 19 patient records reviewed, the registered nurse had not prepared written patient care instructions for the hospice aide. In the chart for RRNHV#1, there were no written aide instructions in the patient chart. The aide had seen the patient for at least one visit and documented assisted with bed bath. This was discussed with the Administrator and Nursing Supervisor. Observed in Record Review. In 1 of 19 patient records reviewed, the registered nurse had not prepared written patient care instructions for the hospice aide. In the chart for RRNHV#4, there was no aide care plan. This was discussed with the Executive Director.”

“Observed in Record Review. The supervising nurse had not assessed the aide’s ability to demonstrate continued satisfactory performance in the following: creating successful interpersonal relationships with the patient and family; demonstrating competence with assigned tasks; complying with infection control policies and procedures; reporting changes in the patient’s condition. These items were not included in the hospice aide supervisory note in the organization’s EMR and thus had not been documented in any chart for a patient receiving aide services, including in the charts for RRHV#1 and RRHV#2 where it was observed. This was discussed with the Administrator and Nurses assisting with record review.”