SSM Health at Home Hospice

“Observed in Record Review. In 18 of 23 patient records reviewed, the organization failed to assess and reassess its patients. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRHV#5, RRHV#6, RRNHV#1- RRNHV#6, Hospice Nurse Surveyor #1 observed the organization failed to document the need for volunteer services in order to offer support or respite to the patient, family, or other caregivers. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#6, RRNHV#1-RRNHV#3, the Hospice Nurse Surveyor #1 observed the organization failed to document an initial bereavement assessment. During conversation with the Hospice Team, it was noted due to a change in an EMR about a year prior to survey the organization was doing the bereavement assessment but there was no documentation of the activities. This was validated with the Hospice Branch Manager. The Hospice Surveyor #2 noted the initial bereavement assessment and the need for volunteer services had not been documented as completed in the electronic medical record (EMR). This had been evident in HOSRRNHV #7, HOSRRNHV #8, HOSRRNHV #9, HOSRRNHV #10, HOSRRNHV #11, and HOSRRNHV #12. This was discussed and reviewed with the Hospice Team.”

“Observed in Record Review. In 11 of 23 patient records reviewed, the organization failed to assess and reassess its patients. During record review for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRHV#5, RRHV#6, RRNHV#1, RRNHV#3- RRNHV#6, the comprehensive assessments did not include documentation of progress towards desired outcomes. Upon conversation with the Hospice Team, it was noted that progress was being documented as progressing which was not measurable. 

This was discussed and reviewed with the Hospice Team. Observed in Record Review. In 1 of 1 patient records reviewed, where the patient had a planned discharge, the Hospice surveyor #2 noted no documentation present in the Interdisciplinary group (IDG) to support the discharge. For example, in HOSRRDC #2, the patient had been deemed no longer terminally ill and was to be discharged. The IDG 2 weeks prior and the day before the discharge had not contained discussion related to the pending discharge. Of note, the IDG 1 day prior still had documentation that the patient had 6 months or less to live. This was validated with the Hospice Branch Manager.”

“Observed in Record Review. During the Bereavement Tracer/Record Review the surveyor noted that in 3 of 3 patient records reviewed, the initial Plan of Care contained a standard statement and goal intended to identify and address bereavement needs during the care of the patient. However, in each of the 3 patients the results of the initial bereavement risk assessment performed indicating low, medium or high risk had not been documented in the Plan of Care to provide a baseline level to enhance monitoring related to this goal. This was discussed with the Bereavement Coordinators and hospice leadership who also described that results of reassessments of bereavement risk would also not be documented in subsequent, updated Plans of Care. 
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“Observed in Record Review. In 3 of 23 patient records reviewed, In 3 of 23 patient records reviewed, the PRN medications did not include indications for use. HOSRRNHV #8 had both Morphine and Oxycodone ordered every 4 hours as needed for severe pain. HOSRRNHV #9 the patient had Oxycodone 2 tabs every 4 hours and Morphine 20mg/ml every 2 hours both ordered as needed for pain without clear indications for which to use first. HOSRRNHV #10 had Morphine ordered for every 2 hours and Tylenol ordered every 4 hour according to PAINAD scale. This was validated with the Hospice Branch Manager. Observed in Record Review. In 5 of 23 patient records reviewed, the organization failed to plan the patient’s care. During record review for RRHV#4, RRHV#6, RRNHV#4, RRNHV#5, and RRNHV#6, PRN medications did not include indications for use. All five patients had Acetaminophen and Morphine for pain with no indication for when to take which medication according to organizational policy. 

This was discussed and reviewed with the Hospice Team.”

“Observed in Patient Home. In 2 of 6 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During home visits for RRHV#4 and RRHV#5, the Hospice Nurse Surveyor #1 observed that staff failed to perform hand hygiene consistent with policy. For example in RRHV#4, the staff did not wash hands before touching the patient and she placed her hand soap inside her front pocket which caused her to reach in with contaminated hands. In RRHV#6, the staff did not change gloves or complete hand hygiene after cleaning genitals and cleaning stool from the patient. She continued on with care, providing a clean towel which she used to dry the patient and then used lotion on the patient body. Also in RRHV#6, the staff member went into bag several times without completing hand hygiene. This was discussed and reviewed with the Hospice Team. Observed in Patient Home. In 1 of 6 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During home visits for RRHV#4 the Hospice Nurse Surveyor #1 observed the staff failed to follow the organizational policy for bag technique. For example in RRHV#4, the staff member left her outside pocket unzipped while walking through the facility and left the middle pocket unzipped throughout her whole visit.

This was discussed and reviewed with the Hospice Team.”

“Observed in Record Review. During the Bereavement Tracer/Record Review, the surveyor noted that in an individual identified by the organization as at high bereavement risk after the death of their partner/spouse, the bereavement care plan did not include specific, individualized interventions. Organization policy states, Standard bereavement includes, but is not limited to: followed by a list of tasks and actions to be performed with no differences or designations identified based upon level of risk assessed. Identification of high risk designation in the bereaved individual required a clear and specific description of interventions included in the post-death, bereavement Plan of Care which were in addition to standard bereavement. This was discussed with the Bereavement Coordinators and hospice leadership. 






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“Observed in Record Review. In 6 of 15 patient records reviewed, the organization failed to plan the patient’s care. During record review for RRHV#4, RRHV#5, RRHV#6, RRNHV#2, RRNHV#3, and RRNHV#6, the aide care plan failed to document safety precautions. For example in RRHV#4, the aide care plan failed to include oxygen on the care plan. In RRHV#5, the aide care plan failed to include oxygen and bleeding precautions. In RRHV#6, the aide care plan failed to include aspiration precautions. In RRNHV#2, the aide care plan failed to include fall risk, oxygen and aspiration precautions. In RRNHV#3, oxygen was not addressed on the aide care plan. And in RRNHV#6, the aide care plan did not include aspiration risk. 

In RRHV#4 the aide care plan written instructions were not accurate. For example in RRHV#4, the patient had catheter care on the aide care plan but the patient did not have a catheter.

This was discussed and reviewed with the hospice team.”

“Observed in Record Review. In 3 of 15 patient records reviewed, where aide services were ordered, the organization failed to supervise effectively. During record review for RRHV#3, RRNHV#2, and RRNHV#3, Hospice Nurse Surveyor #1 observed the organization failed to document Hospice Aide Supervision at least every 14 days. For example in RRHV#3, the Home Health Aide supervision was documented 21 days apart. In RRNHV#2, the supervision was documented at 19 days and 21 days. And in RRNHV#3, the supervision was documented at 21 days. 

This was discussed and reviewed with the Hospice Team.”