Mercyone Des Moines Hospice

“Observed in Record Review. In 7 of 16 patient records reviewed, it was noted that the goals stated on the plan of care were not measurable, timed or patient specific. For example, in review of record for hospice home visit #1 the following was stated as a goal for sleep issues, Pt/CG will verbalize/demonstrate knowledge of pharmacologic and non-pharmacologic strategies to improve sleep/rest pattern within episode of care. In another example for constipation the goal was stated as follows, Pt will maintain optima GI/GU status within disease limitation as evidenced by pt/cg will verbalize /demonstrate ability to list sign and symptoms of complications to report to hospice agency by episode of care. In record review for home visit #2, #3 and #4 the following goals were stated, for the problem of nutrition, Pt and family verbalized understanding of nutritional needs, and for edema, Patients edema/excess fluid will be stabilized ongoing throughout the episode of care. In review of record #9 a goal was stated as follows, Final arrangements will be made by end of episode. In review of record #7 it was noted that a goal was stated as follows, T\Pt/CG to verbalize or demonstrate management techniques related to anxiety by the end of the certification period. This was discussed with the hospice director and quality staff member.”

“Observed in Record Review. In 5 of 16 patient records reviewed, it was noted that the plan of care was not updated to reflect new issues or problems. For example, in review of record for hospice home visit #1 it was noted that the patient had a new foley catheter inserted with a suspected UTI however this was not reflected in the care plan. In review of record for hospice home visit #2 it was noted that the patient had a new earache and was prescribed antibiotic ear drops however the care plan was not updated to include this new problem. In review of record for hospice home visit #3 it was noted that the patient was a high fall risk with a history of frequent falls and frequent UTI’s however neither of these issues were addressed on the plan of care. In review of record for hospice home visit #4 it was noted that the patient had developed a UTI and was treated with antibiotics and had a new order for Kaopectate however the care plan was not updated to reflect these new problems. In hospice record review #8 it was noted that the patient developed a UTI and was treated with antibiotics however the care plan was not updated. This was discussed with the hospice director and quality staff member. Observed in Patient Home. In 7 of 16 patient records reviewed, it was noted that in review of record for hospice home visit #1 the wound care orders were incomplete. For example, the wound care orders stated, cleanse wound with cleanser of choice. Additionally in this record a medication order was stated as Lidocaine patch 4 % apply 1 patch topically if needed for moderate pain to back without a frequency. Lastly in this same record there was no order for a foley catheter to be inserted however a foley catheter was noted while on the visit. In hospice record reviews #5 wound cleanser of choice and skin prep to left heel wound was stated and to be changed daily but there were no dressings ordered. In hospice record review #6 there was no order for a border dressing which was documented in skilled nursing notes as being applied to open areas on neck. In hospice record review #7 the wound care orders stated wound cleanser of choice. In record review #9 and #10 there were no orders for a foley catheter that was documented as being inserted. In HOSDCRR#2 it was noted that there was no discharge order for the patient who was discharged due to no longer meeting hospice criteria. This was discussed with the hospice director and verified by quality staff member.”

“Observed in Record Review. In 6 of 16 patient records reviewed, it was noted that in record review for hospice visits #3 and #4 the plan of care was not followed. For example in record review for visit #3 there was no chaplain visit for the month of March and for visit #4 there was no chaplain visit for the month of January and in both records the visit frequency for chaplain was stated as one time per month. In record review #3 there was a missed hospice aide visit with no documentation of why or who was notified and in record review #4 there were two hospice aide missed visits with no documentation or why or who was notified. In record review #5 there was no chaplain visit for the month of January with a frequency of 1 time monthly and no MSW visit for the month of March with a frequency of twice monthly. In hospice record review #8 there was no chaplain visit made in February with a frequency of one time per month. This was reviewed with hospice leadership.”

“Observed in Record Review. In 2 of 16 patient records reviewed, it was noted that the medication profile did not reflect what the patient was actually taking. For example, in review of record for hospice home visit #3 Dulcolax suppository was listed on the hospice medication profile however it was not on the facility medication profile. In the same record, the facility medication profile listed Senna S to be given daily however that medication was not on the hospice medication profile. In review of record for hospice home visit #4 the facility medication profile stated Ativan 0.25 mg every 4 hours PRN and Kaopectate 30 ml every 6 hours PRN however neither of these medications were on the hospice medication profile. This was discussed with hospice director and quality staff member.”

“Based on clinical record review, hospice policy review and hospice staff interview, the hospice failed to ensure the provision of care in accordance with the patient’s plan of care for 1 of 1 sampled patients (Patient #5) with a pleural catheter (tube inserted into cavity around lung to drain excess fluid). Failure to follow the patient’s Plan of Care as directed by the Interdisciplinary Group (IDG) put the patient at risk for inconsistent care that may not meet the needs of the patient. Findings include: Review of the hospice policy, titled Hospice – Care Planning Process, dated 4/1/2020, identified the hospice ensures that services are furnished in a safe and effective manner and in accordance with the patient’s plan of care. Patient #5 had a hospice admission date of 5/28/25, a death date of 6/16/25 and received hospice services while residing in a private residence. Clinical record review revealed the following: a. Plan of Care update, dated 6/1/25 to 6/12/25 and 6/13/25 to 6/26/25, included primary diagnosis of endometrial cancer and orders for skilled nursing services three times per week and skilled nurse to drain pleural catheter using aseptic technique every other day. Patient/caregiver may perform drainage, site care and dressing change when proficient to maintain ordered frequency and comfort. b. Skilled nurse visit note, dated 6/10/25, included documentation pleural catheter drained with 20-30 milliliters of thick amber fluid. c. Skilled nurse visit notes, dated 6/11/25, 6/12/25, 6/13/25, 6/14/25 and 6/15/25, lacked documentation pleural catheter was drained by skilled nurse, patient, or caregiver, or a reason why the pleural catheter was not drained as ordered. During an interview on 8/5/25 at 1:30 PM, Staff B, Quality Management Specialist/Educator, reported unable to find documentation about pleural catheter being drained after 6/10/25. Skilled nurse failed to drain pleural catheter every other day as ordered or obtain an order to change the frequency to drain the pleural catheter. The findings were reviewed with the Administrator and Quality Management Specialist/Educator.”

“Based on clinical record review, hospice policy review and hospice staff interview, the hospice failed to ensure the Interdisciplinary Group maintained a system for communication and integration of patient care and services to ensure hospice staff provided care in accordance with the plan of care for 1 of 6 sampled patients (Patient #5). Failure of the hospice interdisciplinary group (IDG) members to maintain a system for communication and integration of patient care and services to ensure hospice staff provided care in accordance with the plan of care increased the risk that patients did not receive services to meet assessed needs. Findings include: Review of the hospice policy, titled Hospice – Care Planning Process, dated 4/1/2020, identified the hospice ensures that services are furnished in a safe and effective manner and in accordance with the patient’s plan of care. The patient’s response to care is re-evaluated regularly by the IDG that adjusts the plan of care based on changes in the patient’s condition, psychosocial status, achievement or lack of achievement of goals and outcomes. The IDG makes appropriate decisions such as changes in level of care, interventions and outcomes, visit frequency and continuation of hospice care. Patient #5 had a hospice admission date of 5/28/25, a death date of 6/16/25 and received hospice services while residing in a private residence. Clinical record review revealed the following: a. Plan of Care update, dated 6/1/25 to 6/12/25, included primary diagnosis of endometrial cancer and orders for skilled nursing services three times per week. b. Skilled nurse visit notes, dated 6/3/25 and 6/6/25, included documentation of a completed nursing visit. c. IDG update to the plan of care, dated 6/12/25, lacked documentation the IDG was notified of the missed skilled nurse visit for the week of 6/1/25. The clinical record lacked documentation of a third skilled nursing visit for the week 6/1/25 through 6/7/25, or documentation of a reason for a missed nursing visit. The hospice failed to provide skilled nurse visits as ordered per the IDG updates to the POC. The findings were reviewed with the Administrator and Quality Management Specialist/Educator.”