Vitalcaring Group

“Based on record reviews and interviews, the hospice agency failed to ensure the IDG maintained a system of communication, coordination, and integration of services for 2 (#10 and #15) of 14 (#6, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, and #19) patients reviewed. Patient #10 Review of Patient #10s Clinical Record revealed he was admitted to the hospice agency on 08/01/2023 with diagnoses, which included Alzheimers Disease and History of Falling. Review of Patient #10s Coordination Notes revealed, in part, the following: 03/15/2024 at 1:35 p.m. - Agency office received a call from local assisted living facility reporting Patient #10 fell. Complaining of hip pain. Further review revealed there was no additional documentation regarding Patient #10s fall on 03/15/2024. Review of Patient #10s Calendar and Visit Notes revealed, in part, no visits from agency nursing staff following his fall on 03/15/2024. Review of Patient #10s Physician Orders revealed no new orders following his fall on 03/15/2024. An interview was conducted on 03/19/2024 at 1:10 p.m. with S2RN. She confirmed she provided care for Patient #10. She confirmed she was aware Patient #10 had a fall on 03/15/2024. She stated she was unable to provide documented evidence of her contacting the facility regarding Patient #10s fall. She stated she was unable to provide documented evidence of her notifying the Physician. An interview was conducted on 03/19/2024 at 1:25 p.m. with S1ADM. She reviewed Patient #10s medical record and confirmed she was unable to provide documented evidence to indicate S2RN contacted the facility or notified the physician following Patient #10s fall on 03/15/2024. Patient #15Review of Patient #15s Clinical Record revealed she was admitted to the agency on 03/08/2024 with diagnoses, which included Spinal Stenosis. Review of Patient #15s Social Worker Visit Notes revealed, in part, the following:03/11/2024 - Caregiver and patient noted increased confusion, increased weakness and increased sleeping. Daughter stated patient becoming more and more agitation and experiencing issues with swallowing medications. Review of Patient #15s Coordination Notes revealed no documentation by the Social Worker indicating Patient #15s daughter verbalized the patient had been experiencing issues with swallowing medications. An interview was conducted on 03/19/2024 at 1:00 pm with S1ADM. She reviewed Patient #15s Social Worker assessment documentation completed on 03/11/2024. She confirmed the Social Worker documented he received information from Patient #15s daughter reporting she was experiencing issues with swallowing medications. She confirmed there was no documentation the doctor was made aware and should have been. She said the staff were required to coordinate care to ensure the patients were provided the care they need.”

“Based on interview and record reviews, the hospice agency failed to ensure nursing services met the needs for 2 (#7 and #8) of 3 (#7, #8 and #11) patients reviewed for pressure wounds. The agency failed to follow acceptable standards of practice for wound care by failing to complete weekly wound measurements for Patients #7 and #8. Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management adapted 02/1999 revealed the following in part: Registered nurses render care that is directed towards the prevention and treatment of wounds. Wounds are a common health care challenge that often occur with or result from chronic disorders such as impaired circulation and malnutrition. Nursing care of skin/wound conditions involves the identification, assessment, management, and ongoing evaluation of patients with alterations in skin/tissue integrity that includes but is not limited to draining wounds, pressure ulcers, and vascular ulcers, and conditions resulting from incontinence, surgical procedures, and/or trauma. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning, intervention, teaching, evaluation, and supervision are the major responsibilities of the Registered Nurse in the practice setting. The registered nurse is responsible for performing a nursing assessment and physical examination for preventative and restorative nursing and for providing patient/family teaching. Recognizing that the physician must always prescribe wound care, the following roles are defined to delineate the scope of practice for each member of the nursing team members. The Registered Nurse initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following: Pressure Ulcer Assessment 1. Assess the Pressure Ulcer initially and re-assess it at least weekly. 1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Patient #7 Review of the Clinical Record for Patient #7 revealed he was admitted to the agency on 02/10/2024. Review of the Plan of Care for certification period 02/10/2024 – 05/09/2024 revealed a diagnosis of Pressure Ulcer of Right Lower Leg, Stage 3. Further review of the Plan of Care revealed orders for the following frequency of Skilled Nurse visits: 1 time a week for 1 week then 2 times a week for 13 weeks. Review of the Physicians Orders for Patient #7, dated February 2024, revealed the following: Cleanse wound with wound cleanser. Apply Medihoney, cover with dressing and change every 2 days and prn. Review of the Skilled Nurse visit wound documentation revealed visits were conducted on the following weeks during the current certification period: Week of 02/12/2024, 02/19/2024, 02/26/2024 and 03/04/2024. Further review revealed there was no documentation of weekly completed wound assessments to include measurements for Patient #7. Patient #8 Review of the Clinical Record for Patient #8 revealed she was admitted to the agency on 12/27/2023. Review of the Plan of Care for certification period 02/25/2024- 04/24/2024 revealed a diagnosis of Sacral Pressure Ulcer, Stage 3. Further review of the Plan of Care revealed orders for the following frequency of Skilled Nurse visits: 3 times a week for 8 weeks then 2 times a week for 1 week. Review of the Physicians Orders for Patient #8, dated February 2024, revealed the following: Cleanse with wound cleaner and pat dry with 4x4. Apply bordered foam dressing every 2 days and as needed for loose or soiled dressing. Review of the Skilled Nurse visit wound documentation revealed visits were conducted on the following weeks during the current certification period: Week of 03/04/2024. Further review revealed there was no documentation of weekly completed wound assessments to include measurements for Patient #8. An interview was conducted on 03/18/2024 at 12:50 p.m. with S1ADM. She verified Patient #7 had a Stage 3 Pressure Ulcer to Right Lower Leg and Patient #8 had a Stage 3 Sacral Pressure Ulcer. She reviewed Patient #7 and #8s Clinical Record and verified on the weeks listed above there was no wound measurements documented. She said measurements of the wound should be documented weekly by the Registered Nurse. She said Patient #7s nurse was a new nurse and was unsure if she was aware wounds needed to be measured weekly and Patient #8s nurse reported she thought wounds were required to be documented monthly. She said measurements and description of the wound should be documented weekly by the Registered Nurse and had not been.”