Traditions Health

“Observed in Record Review. In 14 of 14 patient records reviewed, for active hospice patients, the nurse surveyor noted that the goals were not measurable. For example, “Facility staff will verbalize understanding of measures to prevent bleeding.” “ Caregiver will verbalize understanding of nonverbal indicators of pain.” Additionally, all time frames for completion were either for the end of Hospice service or did not have a completion date at all. All findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations. Observed in Record Review. In 4 of 4 patient records reviewed, the noted that the organization did not ensure the individualized plan of care included all required information related to patient goals. For example, in HOSRRHV#3, HOSRRHV#4, HOSRRHV5 and HOSRRHV6, goals for all ordered disciplines did not include an expected to be achieved time frame. For example, Patient/caregiver will verbalized understanding off potential skin breakdown. “Patient at risk for skin integrity will maintain skin integrity. This was reviewed and discussed with the agency’s Clinical Team Leader, Regional Clinical Director and VP of Operations. Observed in Record Review. In 14 of 14 patient records reviewed, for active hospice patients, the nurse surveyor noted that the goals were not measurable. For example, “Facility staff will verbalize understanding of measures to prevent bleeding.” “ Caregiver will verbalize understanding of nonverbal indicators of pain.” Additionally, all time frames for completion were either for the end of Hospice service or did not have a completion date at all. All findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations.”

“Observed in Record Review. In 1 of 20 patient records reviewed, for active records, it was noted by the nurse surveyor that orders were not clear or complete. For HOSRRHV#1, the medication orders were unclear. Acetaminophen 320mg 2 tabs tid was ordered for pain, there was an additional order for Acetaminophen 320mg 2 tabs was ordered prn for pain ordered along with an order for prn Acetaminophen suppositories, the order was unclear when the PRN doses should be given. Finding was discussed with the Executive Director Over Illinois. Observed in Record Review. In 1 of 20 patient records reviewed, for active records, it was noted by the nurse surveyor that orders were not clear or complete. For HOSRRHV#1, the medication orders were unclear. Acetaminophen 320mg 2 tabs tid was ordered for pain, there was an additional order for Acetaminophen 320mg 2 tabs was ordered prn for pain ordered along with an order for prn Acetaminophen suppositories, the order was unclear when the PRN doses should be given. Finding was discussed with the Executive Director Over Illinois.”

“Observed in Record Review. In 3 of 19 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For HOSRRHV#1 (Peoria office), there were no instructions to notify the nurse for a change in the patient’s condition or for skin breakdown. For HOSRRHV#2 (Peoria Office), the patient had an elbow abrasion covered by an elbow pad. There were no instructions to the hospice aide as to what she should do regarding the elbow pad (remove or not remove) during the bath. Additionally, there were no instructions to notify the nurse for a change in the patient’s condition or increased or new skin breakdown. For HOSRRNHV#10 (Decatur Office), the patient was on continuous oxygen and there were no orders as to what to do with the oxygen during the patient’s shower nor when to notify the registered nurse. Findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations. Observed in Record Review. In 3 of 19 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For HOSRRHV#1 (Peoria office), there were no instructions to notify the nurse for a change in the patient’s condition or for skin breakdown. For HOSRRHV#2 (Peoria Office), the patient had an elbow abrasion covered by an elbow pad. There were no instructions to the hospice aide as to what she should do regarding the elbow pad (remove or not remove) during the bath. Additionally, there were no instructions to notify the nurse for a change in the patient’s condition or increased or new skin breakdown. For HOSRRNHV#10 (Decatur Office), the patient was on continuous oxygen and there were no orders as to what to do with the oxygen during the patient’s shower nor when to notify the registered nurse. Findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations. Observed in Patient Home. In 1 of 6 home visits conducted, it was noted by the nurse surveyor that the patient was on continuous oxygen and the care plan did not address whether the oxygen could be removed for the bath was not a useful medication list in the home. This was reviewed and discussed with the agency’s Clinical Team Leader, Regional Clinical Director and VP of Operations.”

“Observed in Patient Home. In 1 of 6 home visits conducted, it was noted by the nurse surveyor that the medication profile was inaccurate. For HOSRRNHV#1, during the visit, the patient asked the nurse where her hemorrhoid cream was, the nurse replied that the patient had run out of it. The nurse assured the patient that she would talk to the patient’s daughter to pick up some more. The Medication Profile did not include the hemorrhoid cream. Findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations. Observed in Patient Home. In 1 of 6 home visits conducted, it was noted by the nurse surveyor that the medication profile was inaccurate. For HOSRRNHV#1, during the visit, the patient asked the nurse where her hemorrhoid cream was, the nurse replied that the patient had run out of it. The nurse assured the patient that she would talk to the patient’s daughter to pick up some more. The Medication Profile did not include the hemorrhoid cream. Findings were discussed and verified with the RN Clinical Team Manager, Executive Director over Illinois, the Regional Clinical Director, and the V.P. of Clinical Operations.”