Heartland Hospice (Broward)

“Upon patient record review, 7 of 19 (Patients #4,#6,#7,#8,#11,#12,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 4: Upon observation during home visit medication reconciliation, the facility medication profile did not contain scheduled docusate that was on the hospice medication profile. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of oxygen instructions on the medication profile. Corrected on site. Patient 7: The medication profile contained oxygen with a delivery method of a BIPAP in error. Patient had a nasal cannula for administration. Corrected on site. Patient 8,12,14: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of oxygen instructions on the medication profile, however an order for oxygen was present. Corrected on site. Patient 11: The medication profile contained Miralax oral powder with no instructions to mix with a diluent. Corrected on site.”

“Upon patient record review, 2 of 19 (Patients #8,#9) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 8: There was no evidence of sacral wound measurements from admission 9/6/24 thru 11/11/24 as required per agency policy for weekly measurements. Patient 9: There was no evidence of wound measurements to left heel, ankle, and dorsum since admission 9/18/24 as required per agency policy for weekly measurements.”

“Upon patient record review, 4 of 19 (Patients #8,#9,#12,#13) 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 8: The medical record contained nursing documentation upon admission identifying patient use of oxygen and history of heart failure exacerbation causing hospitalization. There was no evidence of problems, goals, and interventions related to cardiac and respiratory dysfunction included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included in the plan of care. Corrected on site. Patient 12: The patient is on hospice services with a brain tumor. There was no evidence of problems, goals, and interventions related to neurological dysfunction included in the plan of care. Corrected on site. Patient 13: The medical record contained nursing documentation upon admission identifying patient issue with orthopnea. There was no evidence of problems, goals, and interventions related to respiratory dysfunction included in the plan of care. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #6,#7,#11) 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 medications and treatments. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of oxygen. There was no evidence of an order for oxygen rate, frequency, and delivery method. Corrected on site. Patient 7: The medical record contained an order for oxygen with a delivery method of a BIPAP in error. Patient had a nasal cannula for administration. Corrected on site. Patient 11: The medical record contained an order for Miralax oral powder with no instructions to mix with a diluent. Corrected on site.”

“Upon patient record review, 4 of 19 (Patients #1,#4,#7,#10) 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 medical record contained nursing documentation upon recertification assessment 9/10/24 identifying patient use of a walker, wheelchair, shower chair, and commode. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 4: The medical record contained nursing documentation upon recertification assessment 9/26/24 identifying patient use of a hospital bed, low air loss mattress, and over bed table. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 7: The medical record contained nursing documentation upon recertification assessment 9/30/24 identifying patient use of a walker. There was no evidence of an order for the walker included in the plan of care. Corrected on site. Patient 10: The medical record contained nursing documentation identifying patient use of a bed, wheelchair, oxygen equipment, and nebulizer. There was no evidence of an order for the bed, wheelchair, oxygen equipment, and nebulizer. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #6,#10,#13) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient 6: The medical record contained nursing documentation upon recertification assessment 6/10/24 and 10/7/24 identifying patient issue with dysphagia requiring pureed diet and thickened fluids for aspiration prevention. There was no evidence the plan of care was updated to included problems, goals, and interventions related to dysphagia. Corrected on site. Patient 10: The medical record contained nursing documentation upon recertification assessment 10/15/24 identifying patient issue with increased dysphagia. There was no evidence the plan of care was updated to included problems, goals, and interventions related to dysphagia. Corrected on site. Patient 13: The medical record contained nursing documentation 9/24/24 identifying patient had a fall with right wrist fracture. There was no evidence the plan of care was updated to include problems, goals, and interventions related to fall safety. Corrected on site.”

“Upon patient record review, 2 of 19 (Patients #1,#3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The medical record contained an order for nursing visits twice weekly. There was no evidence of a second visit completed the week of 9/29/24. Corrected on site with late data entry of reason for missed visit. Patient 3: The medical record contained an order for nursing visits twice weekly. There was no evidence of a second visit completed the week of 10/27/24. Corrected on site with late data entry of reason for missed visit.”

“Upon patient record review, 3 of 19 (Patients #15,#16,#17) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 15: There was no evidence of the tasked 6 month phone call completed after death. Patient 16: There was no evidence of tasked phone calls completed at 48-72 hours, 4-6 weeks, and 6 months after death. Patient 17: There was no evidence of the tasked 6 month phone call completed after death.”

“Upon patient record review 7 of 19 (Patients #1,#3,#4,#10,#11,#12,#14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1: The medical record contained an order for aide visits five times weekly. There was no evidence of a fifth visit completed the week of 10/13/24. Corrected on site with documentation of reason for missed visit. Patient 3: The medical record contained an order for aide visits three times weekly. There was one visit documented for the week of 10/27/24. Corrected on site with documentation of reason for missed visits. Patient 4: The medical record contained an order for aide visits three times weekly. There was no evidence of third visits completed the weeks of 9/29/24 and 11/3/24. Corrected on site with documentation of reason for missed visits. Patient 10: The medical record contained an order for aide visits five times weekly. There were three visits completed the week of 9/22/24 and 4 visits completed the week of 10/13/24. Corrected on site with documentation of reason for missed visits. Patient 11: The medical record contained an order for aide visits three times weekly. There was no evidence of a third visit completed the week of 10/6/24. Corrected on site with documentation of reason for missed visit. Patient 12: The medical record contained an order for aide visits two week one then three visits weekly effective 10/13/24. There was no evidence of a second visit completed the week of 10/13/24 and a third visit the week of 10/20/24. Corrected on site with documentation of reason for missed visits. Patient 14: The medical record contained an order for aide visits five times weekly. There was no evidence of a fifth visit completed the weeks of 10/13/24 and 10/20/24. Corrected on site with documentation of reason for missed visits.”