Only Love Hospice

“Observed in Record Review. In 4 of 10 patient records reviewed, the organization failed to ensure the hospice interdisciplinary group update the comprehensive assessment considering changes that have taken place since the initial assessment as frequently as the condition requires but no less frequently than every 15 days. In review of RRNHV#7 it was noted there were gap greater than 15 days at 16 days in August and September in the RN visits to update the comprehensive assessment. In RRNHV#7, RRNHV#8, and RRNHV#9 there were 16 day gaps in IDG meetings to update the comprehensive assessment in June to July and August. In RRNHV#10 there were no documented RN visits to update the comprehensive assessment from the last week of August to current, a 26 day gap. These observations were reviewed with the DON, and Alt Administrator.”

“Observed in Record Review. In 10 of 10 patient records reviewed, the organization failed to ensure the plan of care is bed on the patient’s goals that are individualized, specific, measurable, and time-bound. Throughout the clinical records reviewed the goals were noted to be not be specific, measurable, or time-bound. For example: in RRHV#3 as example was Patient will tolerate tube feeding during plan of care and Patient’s needs will be respected. In RRHV#1 and example was Patient pain will remain at a rating at or below their acceptable level of (Blank). In RRHV#2 example was Patient will maintain adequate cardiac/circulatory function and fluid volume as long as possible. In RRNHV#4 an example was Patient will tolerate tube feeding during plan of care. Further examples of goals that were not specific, measurable, and time-bound could be seen in RRNHV#5, RRNHV#6, RRNHV#7, RRNHV#8, RRNHV#9, and RRNHV#10. These observations were reviewed with the DON and Alternate Administrator. 
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“Observed in Record Review. In 5 of 10 patient records reviewed, The organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#3 the documentation noted ear infections in June and a wound infection in June and July however the infections were not reflected in the plan of care. In RRHV#2 the was documentation of 2 falls with contusion yet the care plan did not reflect the falls. In RRNHV#4 there was documentation of stoma redness requiring sulfa powder, and diarrhea requiring antibiotics yet there were no care plans to guide the care. In RRNHV#6 the patient had copious secretions with documentation of suctioning up to 4 times an hour yet the care plan did not reflect suctioning. There was also documentation of increased seizure activity with medication changes yet the care plan did not reflect the changes. In RRNHV#7 the documentation noted that gastric venting was required prior to tube feeding to prevent nausea and vomiting, yet the venting was not include on the care plan. These observations were reviewed with the DON and Alt Administrator.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions including medications and treatment necessary to meet the patient’s needs. For example: on review of RRNHV#5 there was an incomplete order that read Hydrocortisone 100 mg preservative-free injection 100 mg intramuscular as needed for acute on chronic respiratory failure. There was no frequency noted in the order as required. Further, the patient required in and out catheter multiple times a day but no specific orders for catheterization was noted on the record. In RRNHV#6 there was documentation that there was oxygen available in the home yet no physicians order for oxygen noted on the record. These observations were reviewed with the DON and Alt Administrator.”

“Observed in Record Review. In 2 of 2 patient records reviewed, where aide services were provided, the organization failed to ensure the RN prepare written patient care instructions for the hospice aide. On review of RRNHV#5 the patient was ventilator dependent with a tracheostomy and a G-tube yet there were no instructions on the Aide plan of care to guide the aide on how to handle these devices while providing care. In RRNHV#7 there were no instructions on how the aide was to handle the g-tube site, nor were there parameters for reporting the patient’s temperature. These observations were reviewed with the DON, and Alt Administrator.”

“Observed in Patient Home. In 2 of 3 home visits conducted, the organization failed to ensure the patient record contain all information to reflect the patient’s care, treatment, and services. For example: on home observation for RRHV#2 during medication reconciliation it was noted that the family was giving Aspirin as needed if BP increased to over 160/85, yet the medication was not list as a current medication on the hospice med profile. In RRHV#3 during the medication reconciliation the caregiver noted they were using an inhaler of Ipratropium/albuterol yet the medication profile specified 1 vial of the solution for nebulizer. For the Baclofen the med profile had 5 mg 3 tab TID, yet the bottle stated and the caregiver confirmed the patient was getting 20mg 1 tab TID. There were wound care supplies of Medihoney and wound cleanser on the current med profile yet the RN noted the wound had healed last month. These observations were reviewed with the RN and Director of Nursing.”