Enhabit Hospice

“Based on record review and interview, the agency failed to maintain a system of communication to ensure that care and services were provided according to the plan of care in 1 (#13) of 4 patient records reviewed with a terminal diagnosis of Chronic Obstructive Pulmonary Disease. The failure resulted in Patient #13 not receiving physical therapy services as ordered in the plan of care. Patient #13: Record review of Patient #13’s clinical record revealed a Plan of Care dated 1/30/2024 to 3/17/2024. The Plan of Care indicated that Patient #13 started on the agency’s services on 1/30/2024. The Plan of Care listed Chronic Obstructive Pulmonary Disease (group of disease that cause airflow blockage and breathing related problems) as the terminal diagnosis. Patient #13’s clinical record contained a physician order written by Registered Nurse C which was dated 3/12/2024. The order read; “Patient having difficulty transferring from bed to chair. Physical Therapy 2-3 visits approved. Patient/Caregiver will learn proper techniques for transfers.” During record review on 4/5/2024 at 12:30 p.m. with the Administrator, Alternate Administrator, Director of Nursing, the Alternate Supervising Nurse, the Branch Director for Alternate Delivery Site- Allen, Clinical Operations Consultant Team Lead, Operation Consultant, Senior Quality Outcome Specialist, Vice President of Regulatory Affairs, and the Director of Clinical Excellence, the surveyor discussed physical therapy for Patient #13 and whether Patient #13 had received physical therapy. The Director of Nursing stated, “They haven’t gone yet. Still working with physical therapy to get out.” The surveyor asked what the agencys policy was when orders received for therapy and when physical therapy would start. The Administrator stated, “I will need to look it up.” The Administrator was going to get back with the surveyor. A home visit was conducted on 4/5/2024 at 2:50 p.m. to visit Patient #13. Patient #13 was sleeping in a chair. Patient #13’s Family Member was present. The surveyor asked Patient #13’s Family Member about the physical therapy that had been ordered and had it helped. Patient #13’s Family Member responded, “We haven’t heard from therapy.” Patient #13’s Family Member informed the survey that they needed to call the agency. During an interview on 4/8/2024 at 10:25 a.m. with the Director of Nursing, the surveyor was informed that Patient #13’s therapy should be started this week. The Director of Nursing was asked who was responsible to ensure therapy had been started. The Director of Nursing informed the surveyor that the Registered Nurse Case Manager should have notified the office Clinical Team Leader that therapy had not started. The Director of Nursing was asked why physical therapy had not been started. The Director of Nursing informed the surveyor that physical therapy hadn’t started because they (the contract agency) did not think they had a contract (the agency had a contract with the contract company that had been reviewed by the surveyor). The Director of Nursing was asked how the contract agency was notified of a referral. The Director of Nursing stated, “Through email, I sent the order and the face sheet to the therapy company. They did not get back with me.” The Director of Nursing asked if the surveyor had received the policy that the Administrator was going to give to the surveyor, the “S02.” The policy that was provided was “Admission Process & Patient Assessment (HH only)” that was labeled S02. During an interview on 4/8/2024 at 4:16 p.m. with Registered Nurse C, the case manager for Patient #13. Registered Nurse C informed the surveyor that Patient #13’s Family Member had asked if Patient #13 was eligible for physical therapy. The physician approved 3 sessions during the Interdisciplinary Group meeting and “I wrote the order.” Registered Nurse C informed the surveyor that the Director of Nursing, “Reached out to Home Health about therapy.” Registered Nurse C informed the surveyor that Patient #13’s Family Member had been asked if the therapist had started and was told no one had been out. Registered Nurse C stated, “I notified [the Director of Nursing].” The agency had a policy titled “Admission Process & Patient Assessment (HH only)” that was labeled S02 with a revision date of 10/20/2023. The policy read in part; “Purpose 1.1 Establish criteria for admission of patients into the Agency’s homecare program. 1.2 Establish a clear sequence of events in the intake and admission process to confirm appropriate services and timely start of care...3.0 Policy...Agencies that provide hospice services include...Texas...3.2 The agency follows established procedures for...3.2.2 Consulting with the physician and obtaining a verbal or written order for start of care and any services. Verbal orders will be considered updates to the Plan of Care 3.2.3 Coordinating timely services delivery including communication to appropriate staff members...3.4 Evaluations for additional Licensed Professional services will be conducted as ordered and based on patient needs and/or request, or no later than 1 week post referral...””