Visiting Nurse Health and Hospice

“Based on record review and staff interview, it has been determined that the hospice failed to conduct a full-scale exercise or a tabletop exercise to test the emergency plan vulnerabilities identified in the hazard assessment conducted by the facility. Findings are as follows: Record review failed to reveal evidence that the hospice conducted a full-scale exercise or a tabletop exercise to test their emergency plan. During a surveyor interview on 12/18/2024 at 12:39 PM with the Director of Quality and Compliance, she acknowledged that the required exercises to test the emergency plan were not completed.”

“Based on record review and staff interview, it has been determined that the agency failed to ensure that care and services are provided in accordance with the plan of care for 2 of 2 patients reviewed relative to weekly measurements of pressure wounds, Patient ID #s 6 and 7, and for 2 out of 4 patients reviewed for home visits with medication reconciliation, Patient ID #s 2 and 4. Findings are as follows: Review of the agency policy, titled “;Provision of Care, Treatment, and Services” revealed in part, “;...To provide guidelines to the clinical staff in the management of wounds and ulcers...Document assessment of wound on each visit and measure wound weekly...” a. Record review of the wound report for Patient ID #6 revealed that s/he has a deep tissue injury (DTI, damage to the soft tissue beneath the skin caused by pressure or shear forces) on his/her right second toe with an onset date of 9/30/2024. Further review failed to reveal evidence of DTI measurements on the following weeks: - 9/29/2024 through 10/5/2024 - 10/13/2024 through 10/19/2024 - 11/3/2024 through 11/9/2024 - 11/10/2024 through 11/16/2024 - 11/17/2024 through 11/23/2024 - 11/24/2024 through 11/30/2024 - 12/1/2024 through 12/7/2024 - 12/8/2024 through 12/14/2024 During a surveyor interview on 12/19/2024 at approximately 8:45 AM with the Director of Hospice, she acknowledged that the DTI was not measured weekly. b. Record review of the wound report for Patient ID #7 revealed s/he had a start of care date of 11/30/2024 and was admitted with an unstageable wound on his/her sacrum (a triangular-shaped bone located at the base of the spine, forming the posterior wall of the pelvis) and a right pretibial (front of the shin bone) stage 2 wound (a shallow, open wound that occurs when the skin breaks and exposes the dermis, or the layer of skin below the top layer). Further review failed to reveal evidence that wound measurements were obtained during the initial visit on 11/30/2024. Further review of the wound report failed to reveal evidence that the unstageable wound was measured during the week of 12/8/2024 through 12/14/2024. During a surveyor interview on 12/19/2024 at 3:25 PM with the Director of Hospice, she revealed that she would expect the measurements of the wound to be obtained upon admission and then weekly thereafter. 2. Record review of the agency policy, titled “;Medication Reconciliation” revealed in part, “;...Purpose: To provide a complete list of current medication, including over the counter as well as prescription medications to avoid unintended medication errors... ...To ensure the most accurate, safe, effective and patient centered medication list and resolve any discrepancies of all medications that the patient is taking...by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider, with the current medications the patient has in the home...” a. Review of the medication report for Patient ID #2, a resident of a skilled nursing facility, revealed s/he is prescribed the following medications that includes but is not limited to: - Started 11/21/2024: Bumetanide (diuretic) 0.5 mg (milligram) tablet, give once daily for fluid retention (occurs when parts of your body swell due to a build-up of trapped fluid) - Started 12/5/2024: Duloxetine hydrochloride (antidepressant) 60 mg delayed release capsule, give once daily for depression/pain Review of the hospice plan of care for the patients current ordered medications revealed the following: - Started 8/1/2024: Bumetanide 0.5 mg, give two times daily for fluid retention - Started 10/27/2024: Duloxetine 40 mg delayed release capsule, give once daily for chronic pain During a surveyor interview on 12/19/2024 at 3:29 PM with the Director of Hospice, she revealed that she would expect the patients medications to be reconciled on each visit to address any discrepancies, and that his/her hospice plan of care would match the other providers medication report. b. Review of the hospice plan of care for Patient ID #4 revealed s/he was prescribed Vitamin C 500 mg tablet once daily starting on 2/20/2024, and Dextromethorphan-Guaifenesin oral liquid (medication used to suppress cough) on 8/28/2024. Surveyor observation on 12/19/2024 at 10:57 AM of Registered Nurse, Staff A, reconciling the patients medications in his/her home against the patients current ordered medications in his/her hospice care plan revealed that the patient has stopped taking his/her Vitamin C supplement, and that s/he was taking Guaifenesin instead of the Dextromethorphan-Guaifenesin A subsequent interview was conducted with the patient in which it was indicated that s/he stopped taking the supplement “;...for a while...”, no longer takes the liquid Dextromethorphan-Guaifenesin, and is now taking Guaifenesin 400 mg tablets. Additionally, Staff A then interviewed the patients daughter via telephone and she indicated that the patient has stopped taking the supplement, however she was unsure how long. She then confirmed that the patient stopped taking the liquid Dextromethorphan-Guaifenesin and is only taking the Guaifenesin 400 mg tablets. During a surveyor interview on 12/19/2024 at 3:29 PM with the Director of Hospice, she revealed that she would expect the patients medications to be reconciled on each visit, and that his/her hospice care plan would match the medications that s/he is currently taking.”