Emerald Hospice II

“Upon patient record review, 19 of 19 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients # 1, 2, 3, 4, 5, 6, 8, 9, 10, 11, 13, 14, 16: PRN visits ordered as; nurse 2 PRN visits every 14 days, social worker 1 PRN visit every 30 days, chaplain 1 PRN visit every 30 days. The record did not contain evidence of scope. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN. Patient # 7: PRN visits ordered as; nurse 7 PRN visits every 14 days, social worker 1 PRN visit every 30 days, chaplain 1 visit every 30 days. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN. Patient # 12: PRN visits ordered as; nurse 2 PRN visits every 14 days, social worker 1 PRN visit every 30 days. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN. Patient # 15: PRN visits ordered as; nurse 2 PRN visits every 14 days. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN. Patient # 17: PRN visits ordered as; social worker 1 PRN visit every 30 days, chaplain 1 PRN visit every 30 days. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN. Patients # 18, 19: PRN visits ordered as; nurse 4 PRN visits every 7 days, social worker 1 PRN visit every 30 days, chaplain 1 PRN visit every 30 days. The record did not contain evidence of scope. A discipline’s ordered visit frequency cannot include a PRN visit frequency without a baseline frequency to support it and must include the number of PRN.”

“Upon personnel record review, 1 of 13 (Personnel # 11) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel # 11: The initial competency evaluation did not contain evidence of the following assessment; communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff.”

“Upon patient record review, 18 of 19 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18, 19) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable. Patients # 1, 2, 3, 4, 7, 9, 13, 14, 15, 16, 17, 18, 19: The patient’s most current aide plan of care ordered; aspiration precautions and oxygen precautions. There was no evidence of the frequency. Patient # 5: The patient’s most current aide plan of care ordered; aspiration precautions and fall precautions. There was no evidence of the frequency. Patient # 6, 10: The patient’s most current aide plan of care ordered; aspiration precautions, oxygen precautions and bleeding precautions. There was no evidence of the frequency. Patients # 8, 11: The patient’s most current aide plan of care ordered; oxygen precautions. There was no evidence of the frequency.”