Harbor Hospice of Lake Charles, LP

“Observed in Record Review. In 3 of 20 patient records reviewed, it was noted that the organization did not ensure that the plan of care goals included outcome measures for specific care activities. For example for RRHV#6 the following goal statement (s) were noted [Mrs. Gotreaux will be able to demonstrate improved safety awareness as evidenced by], and [Family/caregiver verbalize/demonstrate measures to achieve optimum comfort level] these goals did not include a method to measure the effectiveness of interventions related to fall prevention and symptom management. Example #2 for RRNHV#5 the goal(s) were noted [Patient will receive adequate hydration] and [Patient will receive adequate nutrition] these goals did not include a method to determine if patient has received adequate hydration/nutrition. This observation was reviewed with the administrator. Example #3 for RRNHV#5 the goal(s) were noted [Patient will receive adequate hydration] and [Patient will receive adequate nutrition] these goals did not include a method to determine if patient has received adequate hydration/nutrition. This observation was reviewed with the administrator. Observed in Tracer Activities. In 3 of 3 of the bereavement care plans developed, the hospice pharmacist surveyor noted these care plans were not individualized post death to reflect appropriate goals with established timeframes for achievement. All three care plans listed as a goal that the bereaved would Verbalize feelings about loss,change and death. This goal had no way to be monitored or measured listed and the timeframe for each of the bereaved to achieve this goal was 13 months. The lack of individualized, measurable goals not being present on the post death care plan was validated with the bereavement coordinator and hospice clinical management at the time of the survey.”

“Observed in Record Review. In 4 of 20 patient records reviewed, it was noted that the organization did not ensure that the plan of care was revised when the patient’s condition changed. For example, during a review of the medical record for RRHV#1, it was noted that during week 12 of the 1st benefit period the patient developed a pressure ulcer at the right heel. The plan of care was not updated with the care, and treatment of the right heel pressure ulcer. Example #2: A review of the medical record for RRHV#2 revealed that during the second week of the 7th benefit period the patient experienced a fall without injury. The plan of care was not updated with interventions to maintain patient safety, and strategies to prevent injury. This observation was reviewed with the Administrator, Observed in Record Review. The organization did not ensure that the plan of care was revised when the patients condition changed. A review of the Interdisciplinary meeting note during week 1 of the 3rd benefit period for RRHV#6, revealed documentation of the following changes in patient condition: (1) Increased constipation – the plan of care was not updated with interventions to address the patient’s symptom of increased constipation; (2) Patient experienced 1 fall without injury during week 2 of the 2nd benefit period, and 2 falls during week 5 of the 2nd benefit period. The plan of care was not updated with interventions to maintain patient safety, and strategies to prevent injury; (3) The interdisciplinary meeting note during week 1 of the 3rd benefit period, the patient was experiencing increased nausea/vomiting. The plan of care was not updated with interventions to address the symptoms of increased nausea/vomiting. Example #2 in the first benefit period of RRNHV#3: (1) the patient had a skin tear measuring 7cm x 7cm on his back and, a stage 2 ulcer to right lateral heel measuring 1cm x 2 cm. The plan of care did not include wound care treatment and/or interventions for care management of the wound(s). This was discussed with the administrator.”

“Observed in Record Review. In 2 of 13 patient records reviewed, for patients receiving hospice aide services, the organization did not ensure the hospice aide plan of care included all safety precautions. For example, during record review for RRHV#3 the patient was currently taking: Clopidogrel (Antiplatelet) 75mg one tablet by mouth daily; ASA 81mg (antiplatelet), one tablet by mouth daily. The aide plan of care did not include an intervention related to bleeding precautions. For RRHV#4 the patient was ordered Oxygen 100% concentrate; Administer 3 liters per minute nasal cannula intermittently as needed for shortness of breath. The aide plan of care did not include an intervention related to oxygen precautions. This observation was reviewed with the administrator.”

“Observed in Record Review. In 4 of 13 patient records reviewed, for patients receiving Hospice Aide services, it was noted that the organization did not ensure Hospice Aide supervision was effective. For example, during the review of the medical record for RRHV#1, it was noted that a Hospice Aide supervision visit was not documented by the Registered Nurse every 14 days. The first Hospice Aide supervision visit was documented 82 days after the start of Hospice Aide services. Example #2: During the review of the medical record for RRNHV#8, it was noted that 21 days after the start of hospice aide services, there was no documented evidence that a hospice aide supervision visit was completed. Example #3: During a review of the medical record for RRNHV#9, it was noted that 79 days after the start of hospice aide services, there was no documented evidence that a hospice aide supervision visit was completed. This observation was reviewed with the Administrator. Observed in Record Review. The organization did not ensure hospice aide supervision was effective. For RRHV#6, the first documented aide supervisory visit was completed 43 days after the start of hospice aide services. This observation was reviewed with the administrator.”

“Observed in Individual Tracer. In 1 of 6 home visits, the organization did not ensure medications were accurately documented on the medication profile. For example, during the home visit activity for RRHV#4 it was noted the medication profile included the following information: Morphine Sulfate 20mg/ml concentrate; take 0.5 milliliters orally or sublingual (sl) every 2 hours as needed for moderate pain (6/10 or less) or shortness of breath. The medication label on the morphine box included the following information Morphine 20mg/ml oral concentrate; Administer 0.5 milliliter(s) orally every 2 hours as needed for severe pain 8-10 or shortness of breath. Example #2: During home visit activity for RRHV#5, the patient was currently taking the following medications: Aspirin 81mg by mouth daily, Aleve 220mg, 2 tablets by mouth every 6 hours as needed for mild pain, Clearlax by mouth every night at bedtime as needed for constipation. These medications were not included on the medication profile. This observation was reviewed the administrator.”