Bridge Hospice

“Based on the interview and record review, the agency failed to notify the physician of the laboratory results for one of the two sample patients (1). As a result, Patient 1’s care and services were delayed. Findings: Per the Hospice Certification and Plan of Care, dated 6/27/23 through 8/5/23, Patient 1 was admitted to the agency on 6/27/23 with diagnoses that included Parkinson’s disease (a brain disorder that causes unintended or uncontrollable movements). Patient 1’s medical record was reviewed, and the following event was documented: On 7/18/23, Skilled Nurse (SN) 1 documented that Patient 1 had an episode of hallucinations over the weekends and possibly had a urinary tract infection (UTI - when bacteria gets into the tube through which urine leaves the body). The family member (FM) reported that Patient 1 had a pungent urine smell. On 7/22/23, SN 1 documented that Patient 1 had difficulty keeping control of the urine in the body, had hallucinations and was easily agitated. On 7/24/23, SN 1 documented that a home visit was conducted, and the physician ordered a urinalysis with culture and sensitivity (to collect a urine sample to detect and manage a wide range of disorders). On 7/27/23, SN 2 documented urine sample was collected. The final report from the laboratory report was released to the agency on 8/1/23, and Patient 1’s urine contained many bacteria. There was no documented evidence that the physician was informed of the results. On 8/10/23, Patient 1 moved to a different agency. SN 1 and SN 2 were not available for an interview. On 4/24/24 at 1:45 P.M., a joint interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated the skilled nurse should have notified the physician of the abnormal lab results and documented them in the patient’s medical record. The DPCS further stated there was no evidence that the SNs notified Patient 1’s physician. Per the agency’s policy and procedure, dated 11/21, titled Monitoring Patient’s Response/Reporting To Physician, “...Clinicians will monitor, document, and report...3. The patient’s physician and/or the hospice Medical Director will be contacted on the same day when the following occur:...G. Results are received for relevant laboratory tests ordered...””

“Upon patient record review, 1 of 14 (Patient #4) did not contain evidence that the comprehensive assessment included a Bereavement component, which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial Bereavement Assessment is incorporated into the Plan of Care and is considered in the Bereavement Plan of Care: Patient #4: SOC was 03/12/24. There was no documented evidence of an initial Bereavement Risk Assessment having been conducted.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1: The RN SOC assessment note, and Physician narrative, reflected that the patient should be on a pureed diet, with thin liquids only; as the patient chokes and aspirates on ‘thickened’ liquids. The POC dated 02/08-05/07/24 listed a pureed diet under the diet section, and included “thickeners” under the DME section of the POC.”

“Upon patient record review, 1 of 14 (Patient #9) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, specifically medications and treatments: Patient #9: The IDG POC dated 04/02/24 included, “Hospice nurse to insert/maintain indwelling Foley catheter 15F/10cc. May irrigate with 30 ml NS or sterile water.” This order does not include an indication/frequency for this physician-ordered irrigation intervention. The same POC included, “Change catheter every 30 days or as needed”, without an indication for such as needed change.”

“Upon patient record review 1 of 14 (Patient #1) did not contain evidence that the Hospice Aide had provided care/services only as: • Ordered by the Interdisciplinary Group; and • Included in the Aide Plan of Care Patient #1: During Surveyor-attended home visit on 04/16/24, tubes of 1) Skin Protectant/Barrier Cream; and 2) Zinc Oxide were noted in the bath supply basin. Upon interview the Aide reported that “yes he did routinely apply these ointments on the patient” during his visits. The application of these ointments were not assigned on the Aide POC.”

“Upon contract review, 1 of 4 (Dr. A.I./Hospice Team Physician) did not contain evidence of a contract to fulfill the role of Alternate Medical Director. When contracting for Medical Director services, the contract must specify the Physician who assumes the Medical Director role/responsibilities and obligations, in their absence. Bridge Hospice had two physicians participating in their Hospice programming. The Surveyor viewed a written agreement for Dr. (B.M.) entitled Medical Director. The other physician’s (A.I.) written agreement was entitled “Hospice Team Physician”, and did not note any references specific to this physician assuming the role/responsibilities of the Medical Director in his/her absence.”

“Upon patient record review, 10 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, and 10) did not contain evidence that all entries were legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice: Patients #1, 8. 9, and 10: All clinical entries made by Aide (TB) did not include his credentials, attached to his signature(s). Patients #2, 3, 4, 5, 6, and 7: All clinical entries made by Aide (VE) did not include her credentials, attached to her signature(s).”

“Upon patient record review, 8 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, and 8) did not contain documented evidence that the Interdisciplinary Group, as part of the review of the Plan of Care, had determined the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his/her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the Hospice must address this issue in the patient’s Plan of Care: Patient #1: Three (3) of 24 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #2: Six (6) of 19 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #3: One (1) of 20 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #4: Twelve (12) of 13 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #5: Five (5) of 11 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #6: One (1) of 9 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #7: Sixteen (16) of 16 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home. Patient #8: One (1) of 16 patient medications listed within the clinical record, did not include documented evidence that the IDG had determined the ability of the patient and/or family to safely self-administer such drugs and biologicals to the patient in his or her home.”