HCA Midwest Hospice & Family Care

“Observed in Record Review. In 4 of 10 medical staff/credentialing files reviewed, The organization failed to include in the plan of care all services needed for the palliation, management of pain and symptoms related to illness as evidenced in RRHV#3: Patient was prescribed pain medication and no goals established. RNHV#3: No goals for aspiration precautions. RRNHV#6:Patient was a diabetic on insulin and checking his blood sugars and no diabetic goals. RRNHV#7: Patient has shortness of breath, no goal identified, patient was also on Keppra for seizures and no seizure precautions goals identified. This was observed and validated by the Director of Quality.”

“Observed in Record Review. In 6 of 10 patient records reviewed, the plan of care did not include interventions to manage pain and symptoms. RRHV#1: Patient was taking Aspirin 81 mgs daily and there were no interventions for bleeding precautions identified. RRHV#3: Patient prescribed pain medication and no interventions established. RRNHV#1: Patient taking warfarin 3mgs at bedtime and no bleeding precautions interventions. RRNHV#3: No interventions for aspiration precautions. RRNHV#5: Patient taking Aspirin 81 mgs daily and no interventions for bleeding precautions. RRNHV#7: Patient has shortness of breath and no interventions identified, patient was also on Keppra for seizures and no seizure precautions interventions identified. This was observed and validated by the Director of Quality.”

“Observed in Record Review. In 3 of 10 patient records reviewed, The plan of care failed to include all services needed for the palliation and symptom management to include drugs and treatments necessary to meet the patient needs as evidenced in RRHV#2: Hydrocodone 5 mgs-Acetaminophen 325 mgs 1 tablet every 8 hours as needed for pain but no indication as to what level of pain to administer medication. RRNHV#2: Patient is a diabetic on insulin and no blood sugar parameters identified. RRNHV#2:Oxygen is order 2-5 liters PRN and no indication to adjust. RRNHV#3: No interventions for aspiration precautions. RRNHV#6: Patient was a diabetic on insulin and checking his blood sugars and no interventions for blood sugar parameters. This was observed and validated by the Director of Quality.”

“Observed in Record Review. In 4 of 10 patient records reviewed, The organization failed to make revisions in the plan of care based on information from updates to the patient’s comprehensive assessment and address the patient’s progress toward goals and outcome as evidenced in RRHV#2: the MSW was discontinued per patient /daughter wishes a month after SOC but goals or interventions not update until 10 months later. RRNHV#1: Goals unchanged since SOC: effective objective signs and symptoms of pain will improve with prescribed intervention by next visit. RRNHV#3: Goals unchanged for 9 months pt/CG will express an increased sense of closure and peacefulness at the end of life. RRNHV#4:Goals unchanged into next benefit period: Patient will verbalize/demonstrate reduction or relief of cardiopulmonary symptoms, this was observed and validated by the Director of Quality”

“Observed in Record Review. In 5 of 10 patient records reviewed, The nursing assistant did not follow the ordered frequency of visits, as evidenced in RRHV#1 the HHA missed a visit the first week of cert and physician was not informed. RRHV#3:HHA missed visits 2 different weeks in first cert period and no documentation to physician. RRNHV#1: HHA missed visits for 3 different weeks during a cert period and physician was not notified. RRNHV#4: HHA did not follow the frequency order which was for twice a week but the HHA did weekly visits and no documentation to notify the physician. RRNHV#5: 3. HHA saw patient once a week instead of twice a week during cert period and physician was not notified, this was observed and validated by the Director of Quality.”

“Observed in Record Review. In 5 of 10 patient records reviewed, The registered nurse who is a member of the interdisciplinary group and is responsible for hospice aide supervision failed to prepare a complete written patient care instructions for the hospice aide to include special precautions as evidenced in RRHV#1: HHA care plan - did not have any special precautions identified for wound dressing. RRNHV#1: HHA care plan, no bleeding precautions patient on warfarin. RRNHV#2: HHA care plan - no indications for special precautions for wound dressing or oxygen. RRNHV#3: Special precautions for HHA for aspirations not identified. RRNHV#5: HHA care plan did not include bleeding precautions, this observed by the Director of Quality”

“Observed in Patient Home. In 1 of 3 home visits conducted, The organization failed to provide an accurate list of medications, including dose, strength, frequency, route and herbal products that relate to the patient’s care, treatment, or services as evidenced in RRHV#1: During the medication reconciliation it was observed that Pro-Stat liquid supplements 15 mls daily was not included in the medical record and the list in the home stated Tramadol 50 mgs 1-2 tablets q 6 hourly PRN and order is for tramadol 50mgs q 6 hours, this was validated by the Clinical RN case manager”