Essence of Life Hospice

“Based on clinical record review and staff interview, the hospice failed to ensure hospice nurse members of the Interdisciplinary Group (IDG) updated the comprehensive assessment with changes to the patient condition regarding wound descriptions and measurements for 3 of 5 sampled patients with a wound (Patient #6, #9, and #19). Failure by the IDG registered nurses (RN) to update the comprehensive assessment with complete wound descriptions and measurements placed the patients at risk for ineffective staff collaboration and communication regarding patients’ wound status and effectiveness of treatments and interventions. Findings include: During an interview on 4/10/24 at 7:55 AM, the Administrator reported the agency expectation was for wounds to be assessed, described, and measured weekly. Measurements include length, width, and depth of the wound. 1. Patient #9 had a hospice admission date of 3/27/24 and received hospice services while residing in a residential care facility. Clinical record review revealed: a. The comprehensive assessment, dated 3/27/24, included documentation of a venous stasis ulcer wound to the left interior ankle measuring 0.5 centimeters (CM) X 0.4cm. The documentation failed to include wound depth. b. The comprehensive assessment, dated 3/27/24, included documentation of a venous stasis ulcer wound to the right lateral ankle measuring 1cm X 1cm. The documentation failed to include wound depth. c. The comprehensive assessment, dated 3/27/24, included documentation of a venous stasis ulcer wound to the right leg just below the knee, measuring 2.5cm X 1.8cm. The documentation failed to include wound depth. d. The comprehensive assessment, dated 4/2/24, included documentation of a wound to the left interior ankle, measuring .54cm X .24cm. The documentation failed to include wound depth. e. The comprehensive assessment, dated 4/2/24, failed to include any assessment, description, or measurements for the wounds on the right lateral ankle and right leg just below the knee. 2. Patient #6 had a hospice admission date of 3/21/24 and received hospice services while residing in a private residence. Review of the clinical record revealed the following: a. The IDG Update dated 3/22/24 and 4/5/24 included orders for skilled nursing service 2 times per week. b. The Comprehensive Assessment, dated 3/21/24, included RN assessment of a skin tear to the patients right hand at a stage 1 and a venous stasis ulcer (a wound on the leg or ankle caused by damaged veins) to the patients left shin as unstageable. c. The Nursing Visit Note on 3/25/24 included assessment of the skin tear to the patients right at a stage 1 and a venous stasis ulcer to the patients left shin as unstageable. d. The Hospice Aide Visit Note on 4/4/24 included documentation that the patient had a new open area to his right forearm and that the RN was notified of this change in condition. e. The Nurse Progress Note on 4/5/24 by a Licensed Practical Nurse (LPN) failed to include assessment of the new open area to the patients right forearm. In an interview on 4/10/24 at 8:45 AM, Staff B, RN, Clinical Manager, reported the agency does not have a policy for wounds. The wound assessments are performed weekly, and staging of wounds was only indicated for pressure ulcers. The hospice failed to accurately assess the patients wounds as the staging of wounds is not consistent with the assessment of skin tears or venous stasis ulcers. The hospice failed to assess the patients new open area to his right forearm. 3. Patient #19 had a hospice admission date of 10/11/23 and received hospice services while residing in a nursing home. Review of the clinical record revealed the following: The IDG meeting notes dated 10/20/23, 11/3/23, 11/17/23, 12/1/23, 12/15/23, and 12/29/23 included orders for skilled nursing services 1-2 times per week. a. The Nursing Visit Note on 10/17/23 included assessment of a skin tear to the patients LLE (left lower extremity) at a stage 2. b. The Nursing Visit Note on 10/30/23 included assessment of the skin tear to the LLE at a stage 2. c. The IDG meeting notes dated 10/20/23, 11/3/23, 11/17/23, 12/1/23, 12/15/23, and 12/29/23 included order to cover skin tear to LLE with foam dressing with a start date of 10/17/23. d. The Clinical Record lacked any assessments of the patients LLE skin tear. e. The Patient Incident Report on 10/30/23 at 7:00 AM included notification to hospice from the nursing home that the patient fell and had a new skin tear to her RLE (right lower extremity). The Clinical Record lacked assessment of the skin tear to the RLE. f. The Triage Note on 12/21/23 at 9:11 PM included a report from the nursing home to hospice that the patient had new wounds to her right foot and 2 wounds to her LLE. g. The Triage Note on 12/22/23 at 5:23 AM included a report from the nursing home to hospice that the patient had a new skin tear to her left forearm. h. The Wound Assessment on 12/22/23 included the skin tear to the left forearm that did not include assessment of the wound bed. i. The Wound Assessment on 12/22/23 included right lower back calf at stage 2. j. The Clinical Record did not include assessment of the right foot wound or the second wound to her LLE. k. The Clinical Record did not include weekly assessments of the patients new wounds as reported by the nursing home on 12/21/23 or as assessed by hospice on 12/22/23. The hospice failed to accurately assess the patients wounds as the staging of wounds and was not consistent with the assessment of skin tears or venous stasis ulcers. The hospice failed to perform weekly wound assessments or clearly document management of the patients wound care. The above findings were reviewed with the Administrator and Staff C, RN. The hospice provided no further information prior to the end of the survey.”

“Based on clinical record review and hospice policy review, the hospice failed to ensure all hospice care and services furnished to patients and their families followed an individualized written plan of care (POC) established by the hospice Interdisciplinary Group (IDG) in collaboration with the attending physician, the patient or representative, and the primary caregiver in accordance with the patient needs for 1 of 3 patients with a catheter (Patient #9). Failure to follow the individualized written POC as directed by the IDG, put the patient at risk for receiving inconsistent care. Findings include: According to the policy titled Plan of Care (POC), dated October 2017, hospice care and services provided to the patient(s) and their families are in accordance with an individualized, written plan of care established by the Interdisciplinary Group (IDG) in collaboration with the patient’s attending physician and, if appropriate, the patient or representative and the primary caregiver. Patient #9 had a hospice admission date of 3/27/24 and received hospice services while residing in a residential care facility. Clinical record review revealed: a. The physician treatment orders, dated 3/27/24, specified a 16 French foley catheter 10 milliliter (ML) bulb with instructions to irrigate with 30ml of normal saline as needed. b. The skilled nurse visit note, dated 3/29/24, identified Staff D, registered nurse (RN), inserted a 20 French foley catheter 30ml bulb and flushed the catheter with 20 cubic centimeters (cc) of sterile saline. c. The IDG notes, dated 4/5/24, did not include communication and/or changes to the physician treatment orders for catheter usage. The hospice failed to follow the individualized written POC placing the patient at risk for inconsistent care. The above information was shared with the Administrator and Staff C, RN. The agency provided no further information prior to the end of the survey.”