Meridian Hospice

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure all entries were legible, clear, complete, and appropriately authenticated in accordance with hospice policy and currently accepted standards of practice. On review of RRNHV#4 there were multiple (9 of 15) RN comprehensive assessment notes dating back to May, that were noted to be in need correction status and therefore did not appear to be completed in the record at the time of survey. In RRNHV#6 there was 4 or 7 RN comprehensive assessments dating back to September noted in need correction status. Further, there was 16 LVN visits noted in need correction status and in RRNHV#7 there were 13 need correction status from September through November. Further examples can be see in in RRNHV#8 in September through November. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the individualized written plan of care included goals that were specific, measurable, and time-bound. On review of RRNHV#6 examples of goals that were not specific and measurable were To manage potential episodes of anxiety and agitation, promoting a sense of calm and comfort for the patient and Alleviate shortness of breath and improve comfort by implementing interventions that promote better oxygenation and reduce respiratory distress, ensuring the patient’s comfort at the end of life. In RRNHV#7 an example was To maintain optimal comfort for the patient while providing food as tolerated and desired. In RRNHV#8 and example was Reduce the frequency and severity of nausea and dizziness by administering prescribed anti-nausea medications as needed, encouraging small, frequent meals or nutritional supplements, and adjusting the patient’s environment (e.g., positioning and hydration) to optimize comfort, while ensuring regular monitoring and documentation of symptoms to tailor care strategies effectively. Further examples can be noted in RRNHV#10 such as Educate the staff on recognizing signs and symptoms of hypo- and hyperglycemia. Promote adherence to the prescribed diabetes management regimen. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 2 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. For example: on review of RRHV#3 there were multiple orders listed on the medication profile for Hydromorphone. One order noted 1 ml sublingual every 4 hours as needed for pain and another order noted 1ml sublingual every 3 hours as needed for pain. There was no indication of which one to use for what situation. In RRNHV#10 there were 4 different PRN morphine orders noted on the medication profile creating confusion. One order stated Morphine 20mg/ml dosage 0.5,.0.3, 0.1 mg(ml) under tongue every 4 hours as needed for shortness of breath/pain without explanation for when to use which dose. Further, separate PRN orders for 0.5 ml (10mg) under tongue every 4 hours as needed, and 0.3 ml (6mg) under tongue every 4 hours, and 0.1ml (2mg) under tongue every 4 hours as needed were included on the medication profile. These observations were reviewed with the Director of Nursing. Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure the plan of care includes all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#1 there was documentation in the record that the wound had healed in October and plan of care updated to reflect yet the wound care order on the medication profile remained active to date of survey. In RRNHV#4 there was documentation of a skin tear healing in July and the plan of care updated to reflect yet the order remained active on the medication profile. Further example of the wound documented and plan of care reflect the wound healed yet the wound care orders remained active on the medication profile was noted in RRNHV#5. These observations were reviewed with the Director of Nursing.”

“Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure the patient record contain information that reflects the patient’s care, treatment and services. For example: on review of RRHV#3 the patient plan of care noted wound care treatment orders yet in October and November the skilled nurse failed to document the wound treatment that was provided. There was documentation such as wound care completed and tolerated with mild discomfort yet no specific documentation of the treatment provided. In RRNHV#5 there was also wound care treatment orders yet in visits documented in August, September and October by the RN there was no documentation of the procedure provided as documentation stated treatment continues and multiple impairments continue treatment as needed and wound care done, tolerated treatment well. In RRNHV#7 there was also documentation of a wound with treatment yet in 5 nursing notes in November there was documentation such as coccyx treatment rendered yet no description of the treatment provided to the patient as required. In RRHV#3 the record was marked that the patient had an allergy to opioids yet there was hydrocodone and hydromorphone on the medication profile. On discussion with the Director of Nursing it was noted that the IDG team discussed that the patient reaction was not a true allergy and the MD approved the opioid medication yet the documentation of the conversation could not be located on the record. These observations were reviewed with the Director of Nursing.”

“Observed in Competency Session. In 2 of 6 contracts reviewed, the organization failed to ensure the services provided by contractual agreement are provided safely and effectively. On review of two contracts for SNF for GIP and Respite the organization had a contract and letter of agreement that lacked all required areas, specifically there was no provision stating the hospice must report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source and misappropriation of patient property by anyone unrelated to the hospice to the SNF/NF or ICF/IID administrator within 24 hours of the hospice becoming aware of the alleged violation. There was no delineation of the responsibilities of the hospice and the SNF, NF, or ICF/IID to provide bereavement services to SNF, NF, or ICF/IID staff. These observations were reviewed with the Administrator.”