Anchor of Hope Hospice

“Observed in Record Review. In 4 of 14 active patient records reviewed,, the organization failed to conduct and document a patient specific comprehensive assessment. in record RRNHV #9 there was no initial spiritual assessment documented. This was reviewed with the Administrator and the Director of Patient Services. Observed in Record Review. In 4 of 14 active patient records reviewed, the organization failed to conduct and document a patient specific comprehensive assessment. In record RRNHV#1 there was no initial spiritual assessment documented. And in records RRNHV#4 and RRNHV#5 there were no initial bereavement assessments documented. This RFI was reviewed with the Administrator, and Director of Patient Services.”

“Observed in Record Review. In 14 of 14 patient records reviewed, plan of care goals were not specific and measurable. Here are some examples: Patient will awaken rested and not be fatigued during day most of the time; patient/caregiver will verbalize or demonstrate feeling supported by hospice team, family, and/or friends and will adapt to changes, challenges and crises throughout hospice admission; patient/caregiver will verbalize understanding of oxygen safety and use of equipment; patient/caregiver will demonstrate how to care for catheter effectively. Additionally, goals were assigned a completion date of either 7, 15, or 30 days. However, most were not completed within those time frames, many had dates moved forward, and some were discontinued and re-written for the next 30 days. The Administrator said that this was done to keep them fresh in the minds of staff. Observed in Record Review. In review of the patient record 1 of 2, the record does not have plan of care goals that are specific and measurable. For example, the documentation of the goals are as follows: the patient will exhibit a decrease in pain related behaviors in 30 days, incontinence of bowel/bladder will be managed by the caregivers for 30 days, patient will receive coordinated care from hospice Interdisciplinary group (IDG) and facility staff ongoing, patient will have acute confusion/agitated behaviors reduced to manage able levels within the limits of the disease in 30 days, and caregiver will verbalize anxiety is absent or reduced to an acceptable level. This was reviewed with the Administrator and the Director of Patient Services.”

“Observed in Record Review. In 1 of 14 active patient records reviewed,, it was noted in RRHV#3 that the Registered Nurse on call visit documentation did not reflect an evaluation of all fall reduction activities including assessment and intervention, education, and an update to the plan of care based on the patient’s changes. For example, three incident reports attached in the patient’s record indicated the patient sustained falls within three days resulting in multiple injuries to include, bruising to bilateral upper extremities, a skin tear to the left forearm and elbow, a possible dislocation of the left thumb, and a wound on the corner of the tongue. Despite these events, the plan of care was not updated to reflect the change in condition. This was reviewed with the Administrator of hospice services.”

“Observed in Record Review. In 14 of 14 active patient records reviewed, interdisciplinary group meeting notes did not document patient decline, progress towards desired outcomes and goals, and plans for the following two weeks. Notes did not include what was discussed. This RFI was reviewed with the Administrator, and Director of Patient Services. Observed in Record Review. In 1 of 2 patient records reviewed the Interdisciplinary group (IDG) documented notes did not identify the patient’s status of decline, goals were not well defined to give a clear indication of the desired outcomes and plans of care for the upcoming two weeks. The record also did not contain documentation as to the discussion of the patient’s status at IDG. This was discussed with the Administrator of hospice and the Director of patient services.”

“Observed in Record Review. In 8 of 14 active patient records reviewed, the organization failed to ensure that the plan of care was current. In record RRHV#1, RRHV#2, RRNHV#2, RRNHV#3, and RRNHV#5 scheduled home health aide visits were missed. And in record RRHV#2 a scheduled spiritual care visit was also missed. There were no orders for these missed visits obtained from the Medical Director. This RFI was reviewed with the Administrator, and Director of Patient Services. Observed in Record Review. In 8 of 14 active patient records reviewed,, the organization failed to ensure that the plan of care was current. In record RRNHV#9 scheduled Registered Nurse and Hospice Aide visits were missed. Also, in record RRNHV #10 a scheduled Registered Nurse visit was also missed. There were no orders for these missed visits obtained from the Medical Director. This was reviewed with the Administrator and the Director of Patient Services.”

“Observed in Record Review. While conducting a review of the patient’s record RRHV #3 it was noted on the hospice aide plan of care, the Registered Nurse delegated wound care tasks to the hospice aide but failed to follow the organization’s policy in delegating tasks to the hospice aide to include documentation of teaching, ensuring supervision, and reevaluation of the delegated task. For example, on the hospice aide plan of care, the Registered Nurse documented instructions on the hospice aide care plan to replace the dressing under the chin if it becomes damaged or soiled and in an updated hospice aide care plan, additional instructions instructed the hospice aide to replace the patient’s wound dressings underneath the chin, left elbow, and left heel should either dressing become damaged or soiled and apply medihoney to the sacrum. This was reviewed with the Administrator of hospice services.”