Best Level Hospice, Inc.

“Upon patient record review, 2 of 14 (Patient #2, 4) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #2: The initial nursing comprehensive assessment identified that the patient was a full code and wanted assistance with funeral planning. The initial MSW assessment did not address findings from the nursing comprehensive assessment. The initial nursing comprehensive assessment stated that the patient/family were experiencing mild spiritual distress, however, this was not addressed in the initial spiritual care assessment. The plan of care did not reflect problems/goals/interventions for psychosocial or spiritual needs identified. Patient #4: The initial comprehensive assessment screening for psych/soc issues states family would like an MSW to assist with funeral planning. The initial social work assessment does not address the need for funeral planning from the nursing comprehensive assessment. The initial comprehensive assessment screening for spiritual distress states that the family would like the SC to contact their local clergy. The initial SC assessment does not address the findings from the nursing comprehensive assessment. The plan of care did not reflect problems/goals/interventions for psychosocial or spiritual needs identified.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1: The SC order for this patient is listed as PRN. There are no scheduled visits to accompany the PRN. The frequency cannot be ‘0’, and the PRN orders cannot stand alone and a discipline’s ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it.”

“Upon patient record review, 6 of 14 (Patient #1, 2, 3, 5, 6, 7) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1: The POC is missing DME, including a hospital bed with 1/2 rails and a bedside commode. Patient #2: The POC is missing DME, including an over bed table, hoyer lift, suction machine, as well as a low air loss mattress. Patient #3: The POC is missing DME, including a wheelchair. Patient #5: The POC is missing DME, including a walker and a wheelchair. Patient #6: The POC is missing DME, including a wheelchair and an E-tank for oxygen backup. Patient #7: The POC is missing DME, including a walker.”

“Upon patient record review, 6 of 14 (Patient #1, 2, 3, 4, 6, 9) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • 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 as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1: The hospice aide assignment stated that the aide should assure that the bed was in low position and side rails were up. The patient did not have a hospital bed on the comprehensive POC. The hospice aide assignment stated that the aide was to apply lotion, however, the assignment did not indicate where the lotion was to be applied. Patient #2: The hospice aide assignment stated that the aide should encourage fluids and that the patient’s diet was “as tolerated”. The nurse assessment and comprehensive POC stated patient was on aspiration precautions with a mechanical soft diet. The assignment also stated that the aide should apply lotion, however, it did not specify the location to apply lotion. Patient #3: The diet on the aide assignment was listed as “as tolerated”, however, the comprehensive POC listed diet as mechanical soft. Patient #4: The hospice aide assignment states that the patient is on a diet as tolerated. It specifies for the aide to assist with feeding. This patient is on a mechanical soft diet. The RN added instructions on the Hospice aide assignment states, “May use walker for ambulation during shower”. This patient is bedbound and unable to hold themselves upright. The assignment orders to apply lotion, however, there is not a location specified for the lotion to be applied. Patient #6: The hospice aide assignment states that the aide is to encourage fluids. It does not state that the patient is on nectar thick fluids. The assignment states for the aide to apply lotion, however, it does not specify the location for the lotion to be applied. The assignment orders for the aide to assure that partial rails are up on the bed, however, the DME on the comprehensive POC states the patient has full rails. Patient #9: The hospice aide assignment orders for the aide to assure that partial rails are up on the bed, however, the DME on the comprehensive POC states the patient has full rails. The assignment does not include bleeding precautions and the patient is on aspirin.”

“Upon patient record review, 2 of 14 (Patient # 2, 4) did not have evidence in the patient record that the interdisciplinary group, as part of the review of the plan of care, determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the hospice must address this issue in the patient’s plan of care. Patient #2: The initial assessment did not include the ability of the patient and/or family’s ability to safely administer medications. Patient #4: The initial assessment did not include the ability of the patient and/or family’s ability to safely administer medications.”