Willamette Vital Health

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed revealed that the agency did not ensure that the comprehensive assessment was completed by the interdisciplinary team within 5 days. Clinical Record 7: Start of care 03/18/2024. Plan of care for episode 03/18/2024 - 06/15/2024 included orders for Spiritual care 1 visit within 5 days from (03/18/2024 - 03/22/2024 and 1-2 times a month for 3 months (03/23/20240 06/15/2024) The clinical record contained a note on 03/21/2024 revealing that the spiritual counselor spoke with patient’s daughter. The daughter reported that the patient would enjoy spiritual care visits. The note did not indicate any reason for not completing an initial assessment visit as ordered by 03/22/224. No assessment visit was completed within five days of the start of care (03/22/2024). No missed visits were documented in the record. Clinical Record 13: Start of care 02/02/2024. Plan of care dated 02/02/2024 includes an order for Spiritual care 1 visit within 5 days (02/02-02/06/2024). Spiritual care assessment was completed on 03/01/2024. The clinical record does not include documentation to explain the delay and no evidence of notification to the physician related to the delay of spiritual care. Reviewed clinical record with Clinical Manager on 04/17/2024. The clinical manager confirmed that the note from the spiritual counselor did not indicate a reason for not completing a spiritual assessment by 03/22/2024 and there was no other documentation in the clinical record to indicate why the spiritual assessment was not completed timely.”

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed revealed that the agency did not ensure that the medication profile included all medications, supplements and herbal remedies and that those medications were reviewed for potential drug interactions. Clinical Record 1: SN assessment on 03/13/2024 described wound care as applying calmoseptine to the great toe. The plan of care included the use of calmoseptine in the wound care instructions for the great toe as an intervention. Calmoseptiine was not included in the medication profile. The clinical record contained no evidence that calmoseptine was included in a drug interaction review. The clinical manager confirmed in an interview on 04/15/2023 that the agency uses third-party software to review for side effects and drug interactions and confirmed that calmoseptine would not have been included because it was not on the medication profile.”

“It is required that each patient’s individualized written plan of care: Identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) records reviewed revealed the agency did not ensure the plans of care contained specific interventions based on the problems identified within the comprehensive assessments. Clinical Record 8: SN start of care assessment on 03/09/2024 revealed that the patient had a nephrostomy and a Foley catheter in place. The assessment noted that the nurse aspirated from the catheter instead of connecting to the draining tube at the wife’s insistence “to pull out any clots”. The assessment noted that the patient has a left-sided nephrostomy with dressing clean dry and intact. The plan of care did not include any goals or interventions related to the foley catheter or the nephrostomy tube. In an interview on 04/18/2024, the clinical manager and education coordinator confirmed that the plan of care did not include any specific interventions regarding the care of the foley catheter or the nephrostomy tube.”

“It is required that each patient’s individualized written plan of care medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed revealed that the agency did not ensure that the plan of care included all medical supplies needed for the care of the patient. Clinical Record 8: The SN start-of-care assessment (03/09/2024) revealed that the patient had a Foley catheter in place as well as a nephrostomy in place with a dressing around the nephrostomy. The plan of care did not include Foley supplies, nephrostomy supplies or dressing supplies. In an interview with the clinical manager and education coordinator on 04/17/2024, the clinical manager confirmed that all required supplies were not listed on the plan of care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed with aide services revealed that the agency did not ensure that the aide care plan provided clear written instructions to the aide to meet the patient’s individualized needs. Clinical Record 8: SN assessment on 03/09/2024 revealed that the patient had a nephrostomy tube on the left side of the trunk with a dressing around it. The aide plan of care developed by RN on 03/09/2024 did not include instruction or notification to the aide that the patient had a left-sided nephrostomy tube with a dressing. In an interview on 04/17/2024 after a joint review of the clinical record, the education coordinator confirmed that the aide’s plan of care did not provide any direction to the aide related to the nephrostomy or the dressing.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group, included in the plan of care, permitted to be performed under state law and regulation consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed revealed that the agency did not ensure that the aide followed the aide care plan and provided services as ordered. Clinical Record 1: Start of care 03/13/2024. The aide care plan developed by RN on 03/13/2024 included the assigned tasks of bed making with linen change every visit, brush/comb hair every visit, apply barrier cream to the coccyx after shower each visit. Aide documented on the visit note on 03/20/2024 “Other” for task brush and comb hair with no further explanation and documented “N/A for today” for the task of linen change with no further explanation. Orders for HHA visits effective 03/13/2024 were 2 times a week for 12 weeks. The aide visits were completed on 03/20/2024, 03/27/2024, 04/02/2024, 04/09/2024, and 04/12/2024. One aide visit was missing each week. In an interview with the Education Coordinator and Clinical Director on 04/15/2024, the Director of Education confirmed that the plan of care was not followed by the aide.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed revealed that the agency did not ensure that plan of care included physician orders for all services and interventions necessary to meet the patient’s individualized need. Clinical Record 8: The SN start-of-care assessment revealed that the patient had a Foley catheter 22f/ 30 ml balloon in place as well as a nephrostomy in place with a dressing around the nephrostomy. The clinical record did not contain any physician orders for a 22f/30Ml balloon catheter and there were no physician orders for the care and management of a nephrostomy tube and dressing. In an interview on 04/17/2024, the clinical manager confirmed that there were no orders for a 22f/30 ml foley catheter or for care of the nephrostomy tube and dressing, and stated in part, “I think the nurse didn’t think about it because the patient came to us with those things in place already.””