Guadalupe Regional Hospice

“Observed in Patient Home. In 2 of 4 home visits conducted, it was noted the organization did not ensure that a thorough and ongoing medication reconciliation process was conducted. It was observed during home visits (RRHV#1, RRHV#2, RRHV#3, RRHV#4) that the nurse provided an updated medication profile to the patient/family without verifying the medications currently in use by reviewing each medication bottle or prescription container during the visit. Based on staff interview, the clinical coordinator had confirmed that the medication reconciliation was limited to the time of admission and recertification. There was no evidence of ongoing verification during routine visits to ensure continued accuracy of the medication list. This finding was discussed and validated by the Administrator and Clinical Coordinator.”

“Observed in Record Review. In 11 of 14 active patient records reviewed, it was noted the organization failed to ensure that the written plan of care was based on measurable patient-centered goals with defined time frames.For example, in the record for RRHV#1, RRHV#2, RRHV#3, RRHV#4, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, RRNHV#7, several goals documented in the plan of care, such as: Pain will be controlled; Skin will stay intact; Patient will understand home and equipment safety; Patient will understand proper use, dosage, and side effects of prescribed medications; Patient will maintain safe use and storage of home oxygen, were not measurable and did not include time frames for expected achievement. All time frames were to be achieved by the time of death. This finding was discussed and validated by the Administrator and Clinical Coordinator. Observed in Record Review. In 3 of 14 active patient records reviewed, most plan of care goals were not measurable and were to be completed by death or discharge in records RRNHV#8, RRNHV#9, and RRNHV#10. Here are examples: Pain to be controlled; skin will stay intact; will understand home and equipment safety; will understand proper use, dosage and side effects of prescribed medications; will maintain safe use and storage of home oxygen; will be knowledgeable of disease process. This RFI was reviewed with the Executive Director Administrator and the Clinical Coordinator.”

“Observed in Record Review. In 3 of 14 active patient records reviewed, the organization did not ensure that the plan of care was revised to reflect changes identified through clinical re-assessment. In record RRNHV#8 the patient developed a DVT in the lower extremity and a pressure ulcer on the buttocks. In record RRNHV#9 Spironolactone was ordered for edema. And in record RRNHV#10 there was documentation of improvement in ambulation, pain, nutrition, and elimination. The plan of care in each record was not updated when these changes occurred. Rather, it was only revised at the time the patient was recertified for an additional benefit period. This RFI was reviewed with the Executive Director Administrator and the Clinical Coordinator.”

“Observed in Record Review. In 2 of 14 active patient records reviewed, the organization did not ensure that all PRN (as needed) orders included a clear indication or reason. For example, in RRNHV#2, an order was written for an indwelling Foley catheter (16 Fr/10 ml balloon) to be changed monthly and/or as needed; however, the order did not specify a clinical indication for the PRN change. Additionally, in RRHV#2, a registered nurse applied a barrier cream and a Mepilex dressing to the patient’s sacral area, but there was no corresponding physician order found to support the intervention. Based on staff interview, the Clinical Coordinator confirmed that the nurse contacted the physician after the home visit to obtain an order, but still no order was found in the clinical record. This finding was discussed and validated by the Clinical Coordinator. Observed in Record Review. In 1 of 14 patient records reviewed, the plan of care did not indicate rationale for a prn order. In record RRNHV#9 a registered nurse documented that the patient had a foley catheter in place at the start of care. An order was written for it to be changed monthly and/or as needed. However, the order did not include criteria for changing the appliance as needed. This RFI was reviewed with the Executive Director Administrator and the Clinical Coordinator.”

“Observed in Record Review. In 1 of 14 active patient records reviewed, it was noted the organization did not ensure that the comprehensive assessment was updated at least every 15 days, as required. For example, in record RRNHV#6, 16 to 17 days elapsed between Interdisciplinary Group (IDG) meetings on two separate occasions. This finding was reviewed with the Administrator and Clinical Coordinator. Observed in Record Review. In 3 of 14 active patient records reviewed, the organization did not ensure that the comprehensive assessment was updated no less than every 15 days. For example, in interdisciplinary group meeting notes written by core team members patient decline, progress towards desired outcomes and goals, and plans for the following two weeks were not addressed in records RRNHV#8, RRNHV#9, and RRNHV#10. This RFI was reviewed with the Executive Director Administrator and the Clinical Coordinator. Observed in Record Review. In 3 of 14 active patient records reviewed, the organization did not ensure that the comprehensive assessment was updated no less than every 15 days. For example, 16 days elapsed between interdisciplinary group meetings two times in records RRNHV#8, and RRNHV#9, and one time in record RRNHV#10. This RFI was reviewed with the Executive Director Administrator and the Clinical Coordinator.”