Oasis Hospice

“Observed in Record Review. In 4 of 4 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable, and time-bound. Throughout all patient records reviewed the goals were not individualized, specific, measurable and time-bound. For example goals that were not measurable in RRNHV#4 the SC goal Daughter verbalized ongoing concerns regarding patient’s condition and expressed emotional difficulty surrounding the progression of decline. Chaplain observed heightened emotional attachment and signs of denial regarding terminal status. Daughter remained present and attentive throughout visit. In RRNHV#2 an example was POC/SN will correctly verbalize understanding of pt fear of the inability to communicate (e.g. non verbal, paralyzed) In RRNHV#1 an example was the need for care when pt is walking with walker ,will be expressed by SN on each visit , to prevent falls. In RRNHV#3 the SC POC goals did not include a time frame, the Target Date was left blank. Further examples can be seen throughout the records. These observations were confirmed and discussed with the Administrator present.”

“Observed in Record Review. In 3 of 4 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. In review of RRNHV#1 the patient was being seen by spiritual care and medical social worker monthly yet there was no documentation of spiritual and/or psychosocial care plans established to guide the care. Also in RRNHV#1 the patient had 2 falls, 1 day after another, and the POC did not reflect the new fall issue. In RRNHV#2 the medical social worker was seeing the patient monthly but no psychosocial care plan had been established. In RRNHV#3 the social worker POC goal and interventions were Resolved with no updated/new goals or interventions. This was confirmed and discussed with the Administrator present.”

“Observed in Record Review. In 2 of 2 patient records reviewed, where the addendum was elected, the organization failed to respect the patient’s right to participate in decisions about their care, treatment, or services. On review of RRNHV#4 the patient/caregiver elected on admission to receive the notice of non-covered items, services, or drugs yet the addendum was not presented to the patient/caregiver until day 11 after benefit election. In RRNHV#7 the notice of non-covered items, services, or drug was elected on admission yet was not documented as presented to the patient/caregiver until day 17. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to ensure the plan of care reflect patient and family goals that were specific, measurable, and time-bound. Throughout all patient records reviewed there goals that were noted to not be individualized, specific, measurable and time-bound. examples of goals that were not measurable in RRHV#1 were Achieve and maintain peripheral circulation for Pt comfort. -Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. -PCG will give medication as ordered, and report to hospice as needed. In RRHV#2 an example was Facilitate bowel elimination and comfort. Facilitate bowel movement. Pt/cg will verbalize/express understanding of medication/treatment orders and side effects. Pt will be encouraged to eat. In RRHV#3 an example was maintain mobility and independence. -Minimize complications due impaired mobility. -Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. -PCG will contact hospice for assistance. Further examples can be seen throughout the records. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 9 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. In review of RRHV#2, RRNHV#4, and RRHV#3 the patient was being seen by spiritual care and medical social worker monthly yet there was no documentation of spiritual and/or psychosocial care plans established to guide the care. In RRNHV#5 and RRNHV#7 the medical social worker was seeing the patient monthly but no psychosocial care plan established. In RRHV#1 the documentation noted cough with wheezing with the addition of prednisone, and diarrhea with changes to the scheduled lactulose but the changes in patient status was not reflected in the care plans. Further, the condom catheter was no longer in use but the care plan remained open and did not reflect the change. In RRNHV#5 the patient documentation of severe pain with multiple changes in medications was not reflected in the care plans. The patient was on Eliquis but no bleeding precautions or care plan to address the risk. The documentation noted 4+ edema with related comfort issues but no care plan to address the edema. In RRNHV#6 there was documentation of a skin tear with treatment but no care plan specific to the issue to guide the care. In RRNHV#7 the documentation noted allergy issues with addition of pseudoephedrine and dizziness with adding Meclizine but the issues were not reflected on the plan of care. In RRNHV#8 there was documentation of pain issues with multiple narcotics and addition of Morphine ER scheduled but no pain care plan open. In RRNHV#9 there was documentation of issues with pain, constipation, and respiratory issues with oxygen use yet no care plans established for pain, gastrointestinal, and respiratory. These observations were reviewed with the Director of Clinical Services, and Administrator.”

“Observed in Record Review. In 5 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 to include mediations and treatments to meet the patients needs. On review of RRNHV#4 there was an incomplete order for wound care that read Clean with normal saline, pat dry with 4 x 4 gauze, apply thin layer triple antibiotic ointment and foam dressing. The order did not have a location, frequency or who was to preform the care. In RRHV#3 the patient was diabetic and there was a goal related to blood glucose monitoring and the intervention noted follow lab orders as specified and report results to MD yet there were no orders for blood glucose monitoring on the record. In RRNHV#5 there was a paracentesis drain with orders to drain 3 times a week yet no specific orders for who was to perform the draining. There were no orders for drain site care nor was the drain care specifically reflected on the care plans. In RRNHV#6 there was documentation of a stage 2 wound to the buttocks on admission but no wound care orders on the record. Also in RRNHV#6 there was an order for care of a skin tear that was incomplete as it had no frequency or who to preform the care. In RRNHV#8 the patient had documentation of a foley catheter but no orders for the catheter nor was the foley reflected in the care plans. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 7 of 10 patient records reviewed, the revised plan of care failed to include information from the patient’s updated comprehensive assessment and did not note the patient’s progress toward outcomes and goals specified in the care plan. In RRHV#3 the care plans were not noted to be updated based on the patient’s progress toward goals as the care plans goals and interventions remained the same IDG to IDG without update based on progress toward goals. Most goals were established on admission and were unchanged to date of survey. Further examples of care plan unchanged based on the patient’s progress to goals could be seen in RRHV#2, RRHV#1, RRNHV#4, RRNHV#5, RRNHV#6, and RRNHV#7. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure written patient care instructions were prepared by the registered nurse. In review of RRHV#1 the aide assigned plan of care noted the patient with a condom catheter and assigned the tasks of replacing the catheter, recording the urine output, and emptying the urine bag. On discussion with the hospice aide the patient’s condom catheter had been discontinued quite some time ago and she was no longer providing the condom catheter care. The RN had not updated the aide assigned tasks to remove the ordered care. In RRNHV#8 the patient had a foley catheter yet no foley care was assigned for the aide. Further, there was no assignment of a bath for the patient yet the aide was providing bathing each visit. These observations were reviewed with the Director of Nursing.”