Global Home Hospice Service, Incorporated

“Observed in Record Review. In 10 of 10 active hospice records with home oxygen therapy, it was noted the organization failed to ensure that the hospice plan of care plan includes all services needed for the palliation and management of the terminal illness and related conditions, including treatment necessary to meet the patient’s needs. For example, in review of record HOSRRHV#1,HOSRRHV#2, HOSRRHV#3,HOSRRNHV#4, HOSRRNHV#6, HOSRRNHV#7, HOSRRNHV#8, HOSRRNHV#9, HOSRRNHV#10, the hospice plan of care included an order for oxygen therapy at 2-4 liters per minute via nasal cannula as needed for shortness of breath. However, the order did not include specific parameters or instructions regarding when oxygen should be initiated or titrated based on severity of dyspnea, oxygen saturation threshold, or other clinical criteria. In record of HOSRRNHV#5, the hospice plan of care included an order for skilled hospice nurse to change the indwelling Foley catheter with a 16 French catheter with 10 ml sterile water balloon once a month and PRN. However, the order did not specify the clinical indications or conditions under which the Foley catheter should be replaced on a PRN basis. This finding was discussed and validated by the Adm/DPCS.”

“Observed in Record Review. In 10 of 10 active hospice records with personal care services, it was noted the organization had failed to ensure that the written patient care instructions for a hospice aide must be prepared by a registered nurse who is responsible for the supervision of a hospice aide. For example, in record of HOSRRHV#1, HOSRRHV#2, HOSRRHV#3, HOSRRHV#4, HOSRRNHV#6, HOSRRNHV#7, HOSRRNHV#8, HOSRRNHV#9, HOSRRNHV#10, a safety precaution was not on the care plan for the hospice aide to follow related to the oxygen therapy while providing care. In record of HOSRRNHV#5, a safety precaution was not on the care plan for the hospice aide to follow related to the oxygen therapy and bleeding precautions (Aspirin). This finding was discussed and validated by the Adm/DPCS.”

“Observed in Record Review. In 1 of 10 active hospice records, it was noted the organization failed to ensure that hospice aide provides services that are ordered by the physician or allowed practitioner in the plan of care, consistent with the aide’s training. For example, in review of record HOSRRNHV#5, the hospice aide care plan instructed the aide to obtain and document the patient’s vitals at every visit. However, review of the hospice aide visit notes revealed no evidence that the patient’s vital signs were obtained or documented during the visits. This finding was discussed and validated by the Adm/DPCS.”

“Observed in Record Review. In 6 of 10 active hospice records with personal care services, it was noted the organization failed to ensure that hospice aide supervision was conducted at the patient’s home no less than every 14 days as required. During review of record HOSRRHV#1, there was a 31-day gap in between aide supervisory visits. HOSRRNHV#4, there was a 15-day gap between documented hospice aide supervisory visits. Additionally, since the supervisory visit conducted during the first of July, 20 days have elapsed without documentation of subsequent hospice aide supervisory visit as of the review date. HOSRRNHV#6, there was a gap of 16 days in between documented hospice aide supervision. HOSRRNHV#8, there was a 15 to16-day gap in between documented aide supervisory visit. HOSRRNHV#9 16 days gap in between documented hospice aide supervision. No documentation in comm note reason for the delay. HOSRRNHV#10 a 31-day gap in between documented aide supervisory visits. This finding was discussed and validated by the Adm/DPCS.”

“Observed in Record Review. In 8 of 10 patient records reviewed, Review of clinical records revealed that clinical visit notes from multiple clinicians remained in an open status. Based on staff interview with the DPCS stated that the majority of the open clinical visit notes were pending for Quality Assurance (QA) review. For example, in record of HOSRRHV#1, clinical visit notes remained unauthenticated for approximately more than 12 months without the author’s electronic signature at the time of record review. In record of HOSRRHV#2, clinical visit notes remained unauthenticated for approximately more than 6 months without the author’s electronic signature at the time of record review. In record of HOSRRNHV#4, clinical visit notes remained unauthenticated for approximately more than 49 days without the author’s electronic signature at the time of record review. In record of HOSRRNHV#6, HOSRRNHV#7, HOSRRNHV#8, clinical visit notes remained unauthenticated for approximately more than 3 months without the author’s electronic signature at the time of record review. In record of HOSRRNHV#9 and HOSRRNHV#10, clinical visit notes remained unauthenticated for approximately more than 5 months without the author’s electronic signature at the time of record review. This finding was discussed and validated by the DPCS.”