Accentcare Hospice & Palliative Care of Texas -San Antonio

“Observed in Record Review. In 10 of 10 active patient records reviewed, the Hospice surveyor noted the goals in patient records were not measurable and specific to the care needs of the patient. On records reviewed goals were not measurable and specific to the patient with timeframes and measures. Examples include: nursing plan of care will be established that meets needs of patient, oxygen levels will be monitored as appropriate, spiritual support as appropriate, pain will be controlled”, caregiver will verbalize mouth care with no timeframe to achieve goal. This finding was reviewed with agency leaders.”

“Observed in Record Review. In 3 of 10 active patient records reviewed, the organization did not individualize the plan of care to reflect the goals and outcomes anticipated. On RRHV #1, patient had started an antibiotic, and the plan of care had not been updated with goals or outcomes for the change in the care plan. On RRHV #3, patient had lost Social Security coverage and the MSW was working with the patient to resolve the matter including helping arrange appointments and calls to social security, but these needs were not reflected on the plan of care. On RRNHV #5, teaching goals from start of care 6 months ago had not been updated to reflect the current needs of patient. This finding was reviewed with agency leadership.”

“Observed in Record Review. In 6 of 10 active patient records reviewed, the medication record was not accurate and reflect duplication of therapy. Agency Medication Profile Policy states the organization will address duplicate therapy. On RRHV #1 it was noted that patient had multiple duplicate PRN therapy for constipation and pain management with no clear indication of when to use each duplicate therapy. For example, PRN constipation orders for Polyethylene Glycol, Bisacodyl and Lactulose with indication of constipation and no indication how to handle the duplication. In addition, PRN pain orders of Hydrocodone/Tylenol, Tylenol supp, and Morphine with indication of pain and no clear instruction how to handle the duplication in therapy. On RRHV #2 it was noted that patient had duplicate PRN medication orders for Morphine and acetaminophen and no indication on how to handle the duplicate therapy. On RRHV # 3, it was noted that patient had duplicate therapy of Benadryl and hydroxyzine PRN for Itching and duplicate pain therapy of Tylenol and Morphine both with no indication how to handle the duplicate therapy. On RRNHV #1 it was note patient had duplicate therapy for cough/congestion of Guaifenesin and Ipratropium neb with no indication how to handle the duplicate therapy. On RRNHV #4 and RRNHV #6 it was noted patient had duplicate pain therapy of Tylenol and Morphine with no indication how to handle the duplicate therapy. This finding was reviewed with agency leaders. Observed in Record Review. In 1 of 10 active patient records reviewed, the organization did not provide care, treatment or services according to the patient’s individual plan of care. In RRHV #1, the surveyor noted that during the home visit, the nurse told the caregiver and patient to administer Lactulose 3 times per day when the plan of care stated Lactulose 2 times per day PRN constipation. On discussion with the nurse after the visit, the nurse stated that she will call the md in the car and get an order for the medication change versus her normal process of doing it in the home. This was reviewed and confirmed with Quality Consultant who was present for the visit. 
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“Observed in Tracer Activities. During the review of the Volunteer Program, the Hospice nurse surveyor identified the that organization did not provide at least 5% of the total patient care hours for the last year. The agency lost all but one of their volunteers and their volunteer coordinator and a new coordinator was hired 6 months ago and working to recruit and train new volunteers. The organization has an active performance improvement plan and tracking the percent monthly and is currently at 2% of total hours. This was reviewed and validated with the agency leaders.”

“Observed in Record Review. In 1 of 10 active patient records reviewed, the medication profile was inaccurate. Agency Medication Profile policy states that the profile will be updated reflecting new changes, modifications and/or discontinued medications and this will be used to teach patient/caregivers during visits. During RRHV#1, it was noted the medication list in the facility was not accurate to reflect changes in medications. The list in the facility was updated 2 months ago and the patient has since had two medication changes (Amoxicillin and change in Lactulose dosing) that were not reflected in the medication list at the board and care facility. This was discussed with the agency leadership.”