Park Nicollet Methodist Hospital

“Observed in Record Review. In 9 of 9 active Hospice patient records with massage therapy ordered, the plan of care have specific orders for the massage therapist. Agency Plan of care policy states that the plan of care will contain the scope, frequency and type of services to be provided to the patient. On HSRRHV #2, HSRRHV #3, HSRRHV #4, HSRRHV #5, HSRRHV #6, HSRRNHV #3, HSRRNHV #7, HSRRNHV #8 and HSRRNHV #10, it was noted that the orders for Massage therapist did not include the scope of the services to be provided it stated “provide massage therapy services to address symptoms” This finding was reviewed and validated with Hospice Leadership team. Observed in Record Review. In 18 of 18 active Hospice patient records reviewed, orders were not specific to the care. Agency Plan of care policy states that scope, frequency and type of service provide be on the plan of care and it is updated as frequently as problems and services change. On all active Hospice records reviewed nursing orders for all patients were ranged at 1-3 visits/week regardless of identified need. In addition, both chaplain and social worker orders were all ranged at 1-4 visits per month regardless of need. This finding was reviewed and validated with Hospice leaders.”

“Observed in Record Review. In 18 of 18 active Hospice patient records reviewed, the organization failed to revise the patient’s plan of care. On review of HSRRHV #1, patient has been on service for 3 months and still has teaching goals for disease process, constipation teaching and oxygen safety that have not been revised to reflect current assessment. On review of HSRRHV #2, the patient has been on service for 9 months and the goals have not been revised to reflect current assessment with the example of teaching goals for understanding of dementia, fall risk, and urine retention. On HSRRHV #3, it was noted that goals had not been updated to reflect assessment since admission 3 months ago with an example of goals for advanced directive planning and bereavement risk assessment. In addition, HSRRHV #4, HSRRHV #5, HSRRHV #6 and RRHV #1-12, the goals were unchanged from admission and not update to reflect the current assessed needs of the patient. This was discussed and validated with the Hospice Leadership Team.”

“Based on interview and document review the agency failed to ensure a discharge summary had been sent to the physician for 1 of 3 patients (P24) reviewed, who were discharged from hospice services. P24’s plan of care (POC) dated 8/12/20, identified P24’s current, 15th benefit period was 6/26/20 through 8/23/20, with a start of care (SOC) date 7/1/19. Diagnoses included coronary artery disease and chronic obstructive pulmonary disease. Service included skilled nurse visits, one to three visits every week for eight weeks to perform for various assessments, education, medication and symptom management. Social work visits were ordered two to five visits every four weeks for eight weeks for various support with goals, resources and end of life changes. On 8/20/23, a home visit was conducted with P24’s social worker and hospice physician. Hospice discharge planning for a hospice initiated discharge due to non-compliance was conducted. A respite hospital stay was to begin 8/21/20, with continued hospice services. Follow up care from the pain management/addiction clinic would be coordinated to begin 8/25/20, at which time P24 was to be discharged from the hospice agency. P24 and her family were in agreement with the discharge plan. On 8/25/20, a hospice discharge note identified P24 was discharged from the hospice agency for cause. The summary failed to identify if a copy of the summary had been sent to P24’s hospice physician or her new primary medical physician. In addition, P24’s medical record lacked physician hospice discharge orders. During interview on 1/31/24, at 12:00 p.m., registered nurse (RN)-C stated it was the agency’s practice to forward a discharge summary to the physician and verified P24’s medical record lacked physician order to discharge from hospice. The agency’s undated policy Hospice Discharge, identified documentation in the patient’s medical record would reflect the discharge planning process, all contacts involved in the discharge planning, including notification to the attending physician and a summary of care. The hospice agency would ensure the attending physician would receive a copy of the hospice discharge summary no matter the reason for discharge.”

“Based on interview and record review, the agency failed to ensure a comprehensive discharge summary of the patient’s stay was completed with all required components for 1 of 3 patients (P24) reviewed who was discharged from hospice services. P24’s plan of care (POC) dated 8/12/20, identified P24’s current, 15th benefit period was 6/26/20 through 8/23/20, with a start of care (SOC) date 7/1/19. Diagnoses included coronary artery disease and chronic obstructive pulmonary disease. Service included skilled nurse visits, one to three visits every week for eight weeks to perform various assessments, education, medication and symptom management. Social work visits were ordered two to five visits every four weeks for eight weeks for various support with goals, resources and end of life changes. On 8/20/23, a home visit was conducted by P24’s social worker and hospice physician. Hospice discharge planning for a hospice initiated discharge due to non-compliance was conducted. A respite hospice hospital stay was to begin 8/21/20, with continued hospice services. Follow up care from the pain management/addiction clinic would be coordinated to begin 8/25/20, at which time P24 was to be discharged from the hospice agency. P24 and her family were in agreement with the discharge plan. On 8/25/20, a hospice discharge note identified P24 was discharged from the hospice agency for cause. The summary failed to include a summary of P24’s stay including current drug profile, and latest physician orders, as required. On 1/31/24, at 12:00 p.m. registered nurse (RN)-C stated it was the agency’s practice to complete a discharge summary which included a summary of stay including medications and orders. A discharge summary with all the required components had not been completed due to P24 had transitioned to an acute rehabilitative unit directly from her hospice respite stay. The agency’s undated policy Hospice Discharge identified the agency would ensure the attending physician would receive a copy of the hospice discharge summary. The discharge summary would include a summary of the patient’s stay including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that would assist in post discharge continuity of care.”