Carepartners Hospice & Palliative Care Services

“Observed in Record Review. In 1 of 19 patient records reviewed, it was noted by the nurse surveyor that the initial bereavement assessment was not completed as part of the comprehensive assessment. For RRNHV#4, the social worker did not complete the initial bereavement assessment at the time she completed her initial social work assessment as was agency practice. Patient was admitted two weeks ago and does not have a documented initial bereavement assessment. Finding was discussed and verified with the RN Clinical Team Manager, the Accreditation Readiness Specialist, the Hospice Educator, and the Hospice Director.”

“Observed in Record Review. In 14 of 14 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized. For example, “Patient/caregiver verbalizes/demonstrates understanding of management of diabetes to prevent diabetic event”, and “Patient will demonstrate reduction or relief of cardiopulmonary symptoms including energy conservation measures, pacing activities, and prn oxygen”. There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety. Additionally, time frames for completion were either at the end of the certification period or not at all. Findings were discussed and verified with the RN Clinical Team Manager, the Accreditation Readiness Specialist, the Hospice Educator, and the Hospice Director.”

“Observed in Record Review. In 2 of 14 patient records reviewed, it was noted by the nurse surveyor that orders were not complete. For RRHV#3, an oxygen concentrator and back up cylinder were obtained for the patient for shortness of breath after the admission. However, a doctor’s order was not obtained. For RRNHV#2, the patient’s foley catheter had been removed, then after a week due to bladder retention, the patient needed it re-inserted, however, a physician order was not obtained. Findings were discussed and verified with the RN Clinical Team Manager, the Accreditation Readiness Specialist, the Hospice Educator, and the Hospice Director.”

“Observed in Record Review. In 8 of 8 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For RRHV#2, the patient had broken her foot, yet the hospice aide care plan had not been revised to indicate the change in weight bearing. For RRHV#3, the patient was on continuous oxygen and the care plan did not address whether the oxygen could be removed for the bed bath. For RRNHV#2, the patient had a foley catheter, it was removed, then reinserted, yet the hospice aide care plan had not been revised to educate the hospice aide on when to notify the skilled nurse. Additionally, none of the hospice aide care plans included instructions to notify the skilled nurse if there were changes in the patient’s condition or any skin breakdown. Findings were discussed and verified with the RN Clinical Team Manager, the Accreditation Readiness Specialist, the Hospice Educator, and the Hospice Director.”

“Observed in Record Review. In 1 of 14 patient records reviewed, it was noted by the nurse surveyor that the patient record was inaccurate. For RRNHV#8, at the time of the IDG meeting due to malfunction of the EMR software, the RN and the Hospice physician were unable to complete their documentation to update the comprehensive assessment. Findings were discussed and verified with the RN Clinical Team Manager, the Accreditation Readiness Specialist, the Hospice Educator, and the Hospice Director who also provided a sign-in sheet and an attached list of the patients discussed at the IDG to verify that the plan of care had been discussed.”

“Observed in Patient Home. In 2 of 4 home visits conducted, it was noted by the nurse surveyor that the medication profile was inaccurate. During RRHV#1, it was noted during the medication reconciliation by the skilled nurse, that the patient was no longer taking the ordered K2 Plus D3 but was taking K- Tab 20 Meq extended Release (also on the medication list). The K2 Plus had not been taken off of the patient’s medication profile. Additionally, the patient had stopped applying the ordered Triamcinolone Acetonide 0.025% topical cream and was now applying over the counter Hydrocortisone cream to her itchy skin. The Triamcinolone Acetonide had not been discontinued and the Prednisone had not been added. Findings were verified by the Registered Nurse Manager who was present during the visit. . For RRHV#4, it was noted during the visit with the Medical Social Worker and conversation with the patient’s son/primary caregiver that the patient was taking one Baby ASA, a Zinc supplement, and Vitamin D3 daily, additionally, the son was administering Trazadone 100mg daily (what the patient was taking prior to going to the nursing home), not the 150 mg she was discharged home on. The medication profile did not reflect these changes. Finding was verified by the PRN RN who was present during the visit.”