Butterfly Hospice

“Observed in Record Review. In 2 of 10 Active patient records reviewed, the organization failed to ensure the update of the comprehensive assessment was accomplished by the interdisciplinary group (IDG) considering changes that took place since the initial assessment. On review of RRNHV#6 there was documentation of all nursing visits refused since mid June leaving 24 days to date of survey since last RN comprehensive assessment. The IDG meeting in mid June failed to update as it noted No changes since last IDG no new orders or meds, POC effective yet nursing visits had been refused during the time period due to the patient’s agitation and refusal of care. The missed visits were not reported in the IDG meeting. In RRNHV#10 there was a 27 day gap in RN visits for comprehensive assessment in May. 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 records review it was not that goals established were not specific and measurable. In RRNHV#4 an example was Promote rest status for Pt/Family/PCG.. In RRNHV#5 a goal read Increase strength/energy for functional activities.. In RRNHV#6 examples of non-specific not measurable goals were Facilitate bowel elimination and comfort and Pt needs will be met on a day to day basis as communicated. In RRNHV#8 an example was Minimize complications due impaired mobility. Further examples of non-specific, non-measurable goals could be seen throughout all records. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 3 of 10 active patient records, 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. On review of RRNHV#5 the patient was being seen by the social worker yet there was no psychosocial care plan to guide the care. The patient also had orders for sliding scale insulin yet no physicians order to specify when and who to conduct blood glucose monitoring. In RRNHV#9 ther was documentation of the patient with a UTI with antibiotics ordered yet the issue was not reflected on the plan of care. On RRHV#3 the patient had a g-tube with tube feeds and a speech therapy consult yet no nutrition care plan to guide the care. These observations were reviewed with DPCS and Administrator.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. On review of RRNHV#7 there were multiple pain medications ordered to include hydromorphone, fentanyl, and MS Contin routinely, and Percocet for breakthrough pain. There was also morphine ordered as part of the comfort kit for as needed use yet there were no specific instructions to guide when to give morphine versus Percocet for as needed use. Further the hydromorphone was ordered as a scheduled frequency of every 4 hours yet the noted instruction section specified to give as needed. These observations were reviewed with the DPCS.”

“Observed in Record Review. In 7 of 10 Active patient records reviewed, the organization failed to ensure that care and services were provided in accordance with the plan of care. On review of RRNHV#6 the patient was ordered a frequency of skilled nursing visits 1 time a week per the plan of care. There was documentation of 5 declined weekly visits, 1 in May, 3 in June, and 1 in July. There was no documentation that there was an attempt to make up the visit during the assigned week at a different time or day to ensure the care and services were provided in accordance with the ordered plan of care. In RRNHV#8 the aide was ordered 2 times a week but failed to document any visits the last week of May, and only 1 visit was documented on the 3rd week of June. In RRNHV#4 the aide was ordered 2 times a week yet no visits were documented since mid June leaving the last 3 weeks prior to survey with no documented visits. In RRNHV#9, RRHV#2 and RRHV#1 the aide was ordered 2 x week yet no visits were documented the last week of May. In RRHV#3 the spiritual counselor was ordered monthly yet no visit for February was documented. In March the spiritual care was declined yet a visit was documented for April. These observations were reviewed with the DPCS and Administrator.”

“Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed to ensure social work services were provided based on the patient’s psychosocial assessment and the patient’s and family’s needs and acceptance of services. On review of RRNHV#10 the initial psychosocial assessment documented that psychosocial services were needed and monthly visits were accepted yet the plan of care order 2 days prior to the assessment noted services were declined. Further, an IDG meeting documentation in June noted that patient experiencing difficulty expressing himself verbally. Social support is needed yet social work services were not provided. This observation was reviewed with the DPCS.”

“Observed in Record Review. In 10 of 10 active patient records reviewed, the organization failed to ensure the medical director, physician member of the interdisciplinary team, or physician designee reviews the clinical information for each hospice patient and provides written certification that the patient’s life expectancy is six months or less if the illness runs its normal course to include all required elements. On review of RRNHV#4, RRNHV#5 the physician narrative on the initial certification stated I certify that this patient has a life expectancy of six months or less, if the terminal illness runs its normal course. If the patient`s condition improves, he will be discharged from hospice care. The narrative did not include all required elements such as current subjective and objective medical findings. Similar lack of physician narrative was noted in RRHV#1, RRHV#2, RRHV#3, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10. These observations were reviewed with the DPCS and Administrator.”

“Observed in Competency Session. In 1 of 1 contracts reviewed, for skilled nursing facility (SNF) the organization failed to ensure the contract with the SNF contained a stipulation that the hospice will report all mistreatment, neglect, or verbal, mental, sexual, and physical abuse to the SNF, NF, or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice, as the verbiage was not found on the SNF contract. This observation was reviewed with the Office Manager.”