Good Heart Hospice & Palliative Care, Inc.

“Observed in Patient Home. In 1 of 3 patient records reviewed, the hospice surveyor observed that the organization failed to provide patient education and training based on the patient’s needs. In HOSRRHV #1 the patient had orders for Metoprolol 25 mg one tablet daily and Losartan 10 mg tablet daily with the parameters to hold if SPB is <100 or HR <60 per the medication orders. The pill bottle in the home that the granddaughter uses did not include the parameters and she stated she was no aware of the parameters. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 4 of 14 patient records reviewed, the organization failed to individualize the patient’s care. In HOSRRHV #3 the patient’s pain goal was assessed to be 4/10 or less but the plan of care stated a pain goal of 3/10 or less. The organization’s Pain Assessment Policy 2-031 stated that the patient’s pain goal will be assessed and entered into the plan of care. For this patient the MSW care plan stated, provide comfort and dignity and emotional well being. The MSW goal is not measurable. In HOSRRHV #2 the MSW goal stated, Patient adjustment to terminal diagnosis and anticipatory grief related to decline. The MSW goal was not measurable. In HOSRRNHV #3 the MSW plan of care stated Patient to remain free of signs or symptoms of psychosocial distress and the Chaplain care plan stated, Chaplain to facilitate a spiritual environment to begin the bereavement process. The MSW and Chaplain goals were not measurable. In HOSRRNHV #4 the MSW plan of care stated, Patient and family will verbalize understanding of hospice services and receive emotional support. The MSW plan of care was not measurable. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 2 of 14 patient records reviewed, the hospice surveyor observed that the Hospice plan of care was missing interventions. In HOSRRHV #1 the chaplain failed to include interventions in the Plan of Care. Additionally, this patient was assessed to be an aspiration risk and the RN did not include a care plan in the plan of care addressing this precaution. During the home visit the patient’s granddaughter asked if a podiatrist could come out to cut the patient’s toenails as they were fungal, thick and curling into the patient’s skin and there was no care plan addressing this in the Plan of Care. In HOSRRHV #3 the patient was taking Hydroxyurea HCL daily for sickle cell disease, there was no care plan addressing this diagnosis and the pain the patient was eliciting during the visit. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 9 of 14 patient records reviewed, the hospice surveyor observed that there were duplicate medications for the same indication. In HOSRRHV #1 the patient had orders for Morphine Sulfate 20 mg orally every 4 hours as needed for mild pain or shortness of breath and there was also an order for Acetaminophen Rectal Suppository 650 mg one every 6 hours and as needed for mild pain or fever >100.1. It was not clear when to take one medication over the other for mild pain. In HOSRRHV #2 the patient had orders for Acetaminophen Rectal Suppository 650 mg 1 every 6 hours and as needed for mild pain or fever >100.1 and she also had orders for Norco 5mg-325 mg one tablet every 6 hours and as needed for pain. It was not clear when the patient should take one medication over the other for pain. In HOSRRHV #3 the patient had an order for Acetaminophen Rectal Suppository 650 mg one every 6 hours and as needed for mild pain and fever >100.1 and he also had an order for Tramadol 25 mg one tablet every day and as needed for mild pain, and Morphine Sulfate 20 mg oral every 4 hours and as needed for mild pain and Shortness of breath. It was not clear which one the patient should take for mild pain. In HOSRRNHV #2 the patient had orders for both Ibuprofen 600mg tablets 1 tablet every 6 hours and as needed for moderate pain, and Tramadol HCL 50 mg one tablet every 6 hours for moderate pain. It is not clear which one the patient should take for moderate pain. In HOSRRNHV #6 the patient had orders for Tramadol 50 mg one tablet every 6 hours and as needed for moderate pain and Norco 5-325 mg 1 tablet every 6 ours as needed for moderate pain. It is not clear which one the patient should take for moderate pain. This patient also had orders for Acetaminophen 500 mg 2 tablets every 12 hours as needed for mild pain and Acetaminophen 650 mg suppository one every 6 hours and as needed for mild pain. It is not clear which one the patient should take for mild pain. In HOSRRNHV #4 the patient had Morphine Sulfate 20 mg oral solution every four as needed for severe pain and Oxycontin 5 mg one tablet every 6 hours for severe pain. It is not clear which one to take for severe pain. In HOSRRNHV #5 the patient was on Tramadol 50 mg one every 12 hours for pain and Acetaminophen Suppository 650 mg one every 6 hours as needed for pain. It is not clear which one the patient should take for pain. In HOSRRDC #1 the patient was on Acetaminophen 325 mg two tablets every 6 hours for pain and also Hydrocodone Acetaminophen 5-325 mg 1 tablet every 6 hours and as needed for pain. It is not clear which medication should be taken for pain. In HOSRRDC#2 the patient was on Morphine Sulfate 20mg/ml sublingual every 4 hours as needed for pain and shortness of breath and Tylenol 325 mg 2 tablets every 6 hours as needed for pain. It is not clear which medication should be taken for pain. This was reviewed and validated with the Administrator.”

“Observed in Patient Home. In 1 of 1 home visits conducted, where the home health aide provided personal care the hospice surveyor observed that she used the same pair of gloves and water to clean the dirty to the clean areas e.g. perineal area. the aide washed the vaginal area then turned the patient and used the same water and gloves to clean her bottom and back. She then dressed the patient and began making the bed with the same gloves. The aide also failed to perform hand hygiene between her glove changes per the Hand Hygiene policy. This was reviewed and validated with the Administrator.”

“Observed in Record Review. In 7 of 14 patient records reviewed, the hospice surveyor observed that the aide assignment did not include specific precautions. In HOSRRHV #3 the patient was on an Eliquis and there were no bleeding precautions in the home health aide assignment. In HOSRRNHV #1 the patient was on Oxygen 3 liters and there were no instructions if the aide could remove the oxygen during bathing. Additionally, this patient was a fall risk and this was not included on the aide assignment as a precaution. In HOSRRNHV #2 the patient was on Oxygen 2 liters and there were no instructions as to what the aide should do when bathing the patient. In HOSRRNHV #3 the patient was on Aspirin 81 mg daily and there was no bleeding precautions in the aide assignment. This patient was also on Oxygen 2-5 liters and the range was in the aide assignment with no instructions what to do with the oxygen during bathing. In HOSRRNHV #6 the patient was on Xarelto daily and the home health assignment did not include bleeding precautions. This patient was also on oxygen 2-5 liters and there were no instructions on what the aide should do with the oxygen during bathing. In HOSRRHV #7 the patient was on 4 liters of oxygen and there were no instructions for the home health aide as to what to do with the oxygen when bathing the patient. In HOSRRNHV #5 the patient was on Oxygen 2-5 liters and the aide care plan did not specify if the oxygen could be removed with bathing. This was reviewed and validated with the Administrator.”

“Observed in Patient Home. In 1 of 2 home visits conducted, where medication reconciliation was performed the hospice surveyor observed that the medication list was discovered to be inaccurate. The hospice surveyor observed in HOSRRHV #3 that the medication list from the organization was missing MiraLAX 17 gm in 8 ounces of fluid daily if no BM for 3 days. Dulcolax suppository 10 gm daily if no BM after the MiraLAX, Naloxone HCL 4 mg spray into each nostril and repeat 2-3 times as needed. Additionally, the Acetaminophen stated 650 mg 2 tablets every 6 hours for pain and as needed but the bottle showed that it was 325mg tablets 2 tablets every 6 hours and as needed for pain. This was reviewed and validated with the Administrator”