Visiting Nurses Hospice

“Based on interviews, record review, and policy review, the agency failed to complete an initial comprehensive assessment within five days of the election of hospice benefits for 1 (Patient 9) of 19 patients reviewed. This deficient practice has the potential to place patient at risk for not receiving care and services in a timely manner. Findings Include: Review of an agency policy titled, “;Care Planning Process,” revised 05/04/20, revealed, “;Procedure 1. At the time of the initial, comprehensive assessment, the Home Health Team Manager/case manager, along with other involved clinicians, develop the patient plan of care based upon the patients identified needs and review it with the patient and/or family/caregiver(s).” A review of Patient 9s “;Hospice Certification and Plan of Care,” dated 10/10/23, revealed the agency admitted Patient 9 on 10/05/23, with diagnoses that included malignant neoplasm of lower lobe right bronchus or lung (lung cancer) and secondary malignant neoplasm of the brain (brain cancer). A review of Patient 9s “;Medical Social Worker Visit,” dated 10/05/23, revealed Patient 9 accepted a spiritual assessment from the agency chaplain. A review of Patient 9s entire clinical record revealed no evidence the chaplain assessed Patient 9 within five days of Patient 9s election of the hospice benefit. During an interview on 11/17/23 at 10:30 AM, the Hospice Manager (HM) stated that the agency process was a nurse and social worker admitted a patient and determined if the patient wanted a spiritual assessment from the agency chaplain. Per the HM, if the patient accepted a spiritual assessment, the agency chaplain would assess the patient within five days. The HM confirmed the agency chaplain did not contact Patient 9 within five days of the admission date to complete a spiritual assessment. During an interview on 11/17/23 at 2:15 PM, the Chaplain stated that he had been notified Patient 9 accepted a chaplain visit for an initial assessment of spiritual care needs but lost track of following up and did not complete the assessment within five days of Patient 9s admission to the agency.”

“Based on interview, record reviews, and policy review, the agency failed to complete an initial bereavement assessment for 3 (Patients 9, 12, and 16) of 19 patients reviewed. This deficient practice has the potential to place the patient’s family and loved ones at risk for the unmet needs to cope with the death and loss of their loved one. Findings Included: Review of an agency policy titled, “;Hospice Bereavement Services,” revised in February 2018, revealed, “;7. A bereavement file will be maintained on each family/caregiver/unit of care. Each file will contain the following information: A. Initial bereavement assessment B. A bereavement plan of care C. All bereavement clinical notes and other pertinent information regarding the bereaved D. Psychosocial assessment of the Hospice patient indicating bereaved family members and bereavement risk factors.” A review of Patient 9s “;Hospice Certification and Plan of Care,” dated 10/10/23, revealed the agency admitted Patient 9 on 10/05/23, with diagnoses that included malignant neoplasm of lower lobe right bronchus or lung (lung cancer) and secondary malignant neoplasm of the brain (brain cancer). A review of Patient 9s clinical record revealed no evidence of a completed initial bereavement assessment. A review of Patient 12s “;Hospice Certification and Plan of Care,” dated 08/28/23, revealed the agency admitted Patient 12 on 08/22/23, with diagnoses that included chronic obstructive pulmonary disease and protein-calorie malnutrition. A review of Patient 12s clinical record revealed no evidence of a completed initial bereavement assessment. A review of Patient 16s “;Hospice Certification and Plan of Care,” dated 03/13/23, revealed the agency admitted Patient 16 on 03/10/23, with diagnoses that included acute on chronic congestive heart failure and acute respiratory distress. A review of Patient 16s clinical record revealed no evidence of a completed initial bereavement assessment. During an interview on 11/17/23 at 10:30 AM, the Hospice Manager stated that the agency policy was staff should complete an initial bereavement assessment during the patients agency admission visit. The Hospice Manager confirmed the agency did not complete an initial bereavement assessment for Patients 9, 12, or 16, and acknowledged the agency did not follow its policy.”

“Based on interview, record reviews, and policy review, the agency failed to provide services as ordered in the Hospice Certification and Plan of Care (POC) for 3 (Patients 1, 7, and 10) of 19 patients reviewed. This deficient practice place patients at risk for unmet care needs and services. Findings Include: Review of an agency policy titled, “;Care Planning Process,” revised 05/04/220, revealed, “;4. The care planning decisions should be reflected in the specific services which will be provided and the associated actions planned and implemented to meet individualized patient problems and goals.” A review of Patient 1s “;Hospice Certification and Plan of Care,” dated 09/27/23, revealed the agency admitted Patient 1 on 01/24/23, with diagnoses that included Alzheimers disease and elevated white blood cell count. Per the Hospice Certification and Plan of Care, Patient 1 discipline orders included “;Skilled Nursing; 2 wk [week] 8 wk 7 PRN [as needed]” beginning the week of 09/21/23. A review of Patient 1s clinical record revealed no evidence the agency provided two skilled nursing visits to Patient 1 during the week of 09/21/23. A review of Patient 7s “;Hospice Certification and Plan of Care,” dated 08/28/23, revealed the agency admitted Patient 7 on 08/25/23, with diagnoses that included malignant neoplasm of prostate and secondary malignant neoplasm of bone. Per the Hospice Certification and Plan of Care, Patient 7 discipline orders included “;Skilled Nursing; 1 wk 1wk; 2-3 wk 12 wk; 2 wk 1 wk” beginning the week of 08/25/23. A review of Patient 7s clinical record revealed no evidence the agency provided at least two skilled nursing visits to Patient 7 during the week of 09/03/23. A review of Patient 10s “;Hospice Certification and Plan of Care,” dated 10/27/23, revealed the agency admitted Patient 10 on 10/25/23, with diagnoses that included mild protein-calorie malnutrition and dementia. Per the Hospice Certification and Plan of Care, Patient 10 discipline orders included “;Skilled Nursing: 2 wk 13 wk 7 PRN” beginning the week of 10/25/23. A review of Patient 10s clinical record revealed no evidence the agency provided two skilled nursing visits to Patient 10 during the week of 10/25/23. During an interview on 11/17/23 at 9:50 AM, the Hospice Manager (HM) stated that the agency expectation was services should be provided as ordered by the patients physician and documented in the patients plan of care. The HM confirmed the agency was to provide Patient 1 two nursing visits during the week of 09/21/23, Patient 7 two nursing visits during the week of 09/03/23, and Patient 10 two nursing visits during the week 10/25/23, and the agency did not provide these visits as ordered in the patients POCs. The HM acknowledged the agency did not follow its policy.”