Goshen Home Care and Hospice

“Observed in Record Review. In 3 of 14 patient records reviewed, hospice services were not provided according the hospice plan of care. For HOS RRNHV #1 Spiritual Care Service visits were planned 2 times a month for 2 months however in review of the medical record there was no evidence that the Spiritual Counselor made a visit in the second month following the Election of the Hospice Benefit. Also, for HOS RRNHV #2 Spiritual Care Service visits were planned 1 time a month for 3 months and in review of the medical record there was no evidence that the Spiritual Counselor made a visit in the third month following the Election of the Hospice Benefit and documentation in the IDG notes stated that the Spiritual Counselor planned to increase visits to weekly, however there was no evidence of those visits. Finally, for HOS RRNHV #4 Social Work visits were planned 2 times a month however in review of the medical record there was only one visit made by the social worker in the second month following the Election of the Hospice Benefit. This was validated with the Hospice Team Lead.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the organization did not collaborate in the care of the patient and coordinate their efforts to support the goals outlined in the hospice plan of care. The organization did follow the Hospice Interdisciplinary Group (IDG) policy for HOS RRHV #2 that states any changes in the hospice plan of care are discussed with the patient and are approved by the hospice before implementation. In review of the inpatient record for HOS RRHV #2 who was receiving respite care the surveyor noted that the medications Zofran and Aspirin were included on the inpatient medication list and that there was a wound care order by the wound care nurse however there was no evidence of communication with or approval by the Hospice program. This was validated with the Inpatient Director of Nursing and Hospice Team Lead.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the patient record did not contain required clinical information including; any specific notes on care, treatment, or services specifically the hospice plan of care, and information required by organization policy, in accordance with law and regulation including the Election of Hospice Benefit and a list of medications. For HOS RRHV #2 who was receiving respite care there was no evidence that the in-patient medical record contained the required documentation including the Certification of Terminal Illness (CTI), the Interdisciplinary Group Plan of Care, and medication list. This was validated with the Inpatient Director of Nursing and the Hospice Team Lead.”

“Observed in Patient Home. In 1 of 4 home visits conducted, the surveyor noted that the contracted DME had stored oxygen tanks in the home unsecured. During the survey visit for HOS RRHV #4 the daughter who was the primary caregiver reported that the DME had delivered the oxygen concentrator and back up oxygen which was standing and unsecured without a stand. This was validated with the Hospice RN. Observed in Record Review. In 2 of 14 patient records reviewed, the organization had not provided education based on the patient’s assessed needs. In review of the medical record for HOS RRHV #1 the patient’s spouse contacted the after hours on call number at 1:30 a.m. reporting the patient was unresponsive and he wanted to know about giving the next dose of Morphine and Lorazapam. The husband was instructed to HOLD the dose. During the survey visit the patient was observed to become restless and the husband reported to the MSW that the patient had not had any medication since 9:00 p.m the previous evening as he understood the directions from the On Call service were to not give any more medication. The RN who was on the survey visit as an observer educated the husband on the use of the prn comfort medications and told him that the Hospice nurse would be visiting that afternoon and would go over the medications with them. In review of the medical record for the skilled nursing visit on that date there was no documentation or evidence that education had been provided to the husband on management of the patient’s medications. Also, in review of the medical record for HOS RRNHV #3 there was an order for the patient to begin Augmentin to treat a respiratory infection however, in review of the Skilled Nursing Visit note there was no evidence that the RN had provided teaching/education to the patient regarding the medication. This was validated with the Hospice Team Leader.”

“Observed in Patient Home. In 1 of 14 patient records reviewed, the organization had not provided care, treatment, or services according to the patient’s individualized plan of care. For HOS RRHV #2 who was receiving respite care on the inpatient unit care was not provided according to hospice plan of care. In review of the inpatient medical record the patient was receiving Zofran and Aspirin which were not part of the Hospice Plan of Care. Additionally, the inpatient unit was not following the Hospice Plan of Care for wound care to the right buttock which were to cleanse with soap and water, pat dry, apply zinc cream. In review of the inpatient record there was an order by the Wound Care RN for a foam dressing. There was no evidence in the medical record of communication/coordination between the inpatient unit and the Hospice program. This was validated with the CNO and Director of Nursing for the inpatient unit.”

“Observed in Record Review. In 1 of 14 patient records reviewed, there was no evidence in the inpatient medical record of the patient’s most recent hospice plan of care, the patient’s hospice election form, the physician certification of terminal illness, information on the hospice medications for the patient and orders from the hospice physician and attending physician, for the patient. In review of the medical record for HOS RRHV #2 who was on respite care there was documentation in the Hospice program medical record that the required documents had been provided to the in patient unit however there was no evidence of the required documents or documentation that the documents were received. In conversation with the Hospice RN and the Inpatient Director of Nursing they reported that there was not a process in place to share medical information and coordinate care.In conversation with the Hospice RN and the Inpatient Director of Nursing that a process was in place to share medical information and coordinate care.”