Ipr Healthcare System Inc.

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identified the patient’s need for hospice care and services. On review of HosRRNHV#5 the patient was diabetic with orders for Insulin and two oral hypoglycemics, yet there was no documentation of an endocrine system review on admission or elsewhere in the record. In HosRRNHV#10 the initial nursing assessment documentation noted there was a wound, however there was no wound assessment noted in the documentation. These observations were reviewed with the ADON.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the organization failed to update the comprehensive assessment. On review of HosRRHV#2 the IDG meeting failed to update the comprehensive assessment. In the documentation for the most recent IDG meeting there was no mention that the patient had a foley catheter added since last IDG meeting. The IDG documentation stated no lines, tubes, or devices in place yet a foley catheter had been placed since the last IDG. In review of HosRRNHV#6 the patient had a change in level of care as they went respite, yet the changes were not discussed in the update to the comprehensive assessment during the IDG meeting. These observations were reviewed with the DON and ADON.”

“Observed in Record Review. In 8 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. In HosRRHV#1 the documentation and conversation with the patient’s husband noted that anxiety/agitation was an ongoing issue for the patient. There was documentation of the use of ABH cream and increase in the Haldol dosage yet no care plan related to the anxiety/agitation open to guide the care. In HosRRHV#2 the documentation noted the patient had a seizure that required a PRN visit and use of Lorazepam yet there were no seizure precautions noted on the plan of care nor was seizure risk addressed on the care plan. In HosRRHV#3 there was documentation of swelling in the patient’s neck prompting a PRN visit and ongoing monitoring yet there was no care plan opened to address the issue. In HosRRNHV#5 the patient was diabetic with insulin and multiple oral hypoglycemics, yet the issue was not addressed in the care plan. In HosRRNHV#6 the patient had a change in level of care to respite and back for caregiver relief, but the changes were not reflected in the plan of care. Further, the documentation noted poor appetite with increased protein needs but no care plan to guide the care. In HosRRNHV#7 the documentation noted issues with anxiety utilizing ABH cream and Haldol, and issues with pain requiring Fentanyl but no care plans to address the issues. The patient had multiple UTI’s with antibiotic orders yet the care plan for urinary was not updated to reflect the changes. In HosRRNHV#8 the patient had an ear infection and increased agitation requiring changes in Seroquel dosage, yet the issues were not reflected in the care plans. In HosRRNHV#10 the patient’s terminal diagnosis was End Stage Heart Disease yet there was no cardiovascular care plan to guide the care. These observations were reviewed with the ADON.”

“Observed in Record Review. In 10 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. On review of HosRRHV#3 the patient’s wife noted they were using Thickener to honey consistency related to swallowing difficulties yet there were no orders for the thickener noted on the plan of care. There were two orders for Carafate, one liquid and one tablets yet there were no specific instructions to guide the user when to use each one. In HosRRHV#1 there were range orders for Morphine Concentrate and Lorazepam yet no specific instructions to guide the user in when to use what dosage. Such as Morphine Concentrate 100mg/5ml give 0.25ml - 1ml Q1H as needed for pain and shortness of breath, and Lorazepam 0.5 mg give 1-2 tabs as needed for anxiety/shortness of breath. Range orders for Morphine and/or Lorazepam could be seen in all records reviewed as the orders were part of the comfort kit orders. In HosRRNHV#5 the documentation noted skin tears with treatment provided yet no wound care orders noted on the plan of care. In HosRRNHV#9 there were multiple orders for PRN anxiety medication two for Lorazepam and one for Alprazolam yet no specific instructions to guide the user as to which one to choose for what situations. These observations were reviewed with the ADON.”

“Observed in Record Review. In 6 of 10 patient records reviewed, the organization failed to ensure plan of care revisions were based on information from updates to the patient’s comprehensive assessment and address the patient’s progress toward goals and outcomes. On review of HosRRNHV#4 there were goals that had not been updated based on the comprehensive assessment. The goals had target dates that were past without update, such as: Patient will report a decrease in pain score from 5/10 to 1/10 on a numerical rating scale by (date in Feb). Examples of goals without update past the achieve by/target dates that were: In HosRRNHV#6 Patient will rate the pain scale lower than the initial rate at a level that is acceptable to them or 0/10 by (date in April). In HosRRNHV#7 an example was Patient will achieve a normal elimination pattern free from frequency and urgency by ( date in June of 2025). In HosRRNHV#8 an example was Patient will report averaging 7-9 hours of restful sleep per night by (date January). Further examples could be seen in HosRRHV#3, and HosRRNHV#9. These observations were reviewed with the ADON.”

“Observed in Record Review. In 3 of 10 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. On review of HosRRNHV#7 the Spiritual Counselor (SC) was order a frequency of 1 x month but there were no documented visits in July, October, or November, nor any documentation as to why the visits were not made. In HosRRNHV#8 the SC was also ordered 1 x month but there were no documented visits in January, February or March. In HosRRHV#3 the SC was also ordered 1 x month yet visits were not documented monthly as early documentation noted services were declined but the frequency remained active on the plan of care. These observations were reviewed with the ADON.”

“Observed in Record Review. In 2 of 9 patient records reviewed, where hospice aide services were provided, the organization failed to ensure written patient care instructions for the hospice aide were prepared by the registered nurse. On review of HosRRHV#2 the patient had a foley catheter, yet the catheter was not noted on the aide assignment nor was foley care assigned as a task for the aide. In HosRRNHV#9 there was documentation the patient had a wound with wound treatment. There was no instructions for the aide on how to handle the wound while providing care. This observation was reviewed with the DON and ADON.”

“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. On home observation of medication reconciliation the medication profile as part of the medical record did not match the medications noted in the home. In HosRRHV#2 there was an order for oxygen yet the patient’s wife stated they did not have oxygen in the home. Mirtazapine was ordered and the patient had not been taking for a while and Dexamethasone had been stopped per the wife a week or two ago. Further, the wife noted she had been giving Ibuprofen yet Tylenol was ordered. She stated she did not have Tylenol in the home. In HosRRHV#3 the medications scopolamine, Claritin, Flonase, Ammonium Lactate lotion, Magic Mouthwash and Lorazepam were ordered in the record yet the caregiver noted the patient was not taking the medications and they were not in the home. There was Cetirizine liquid in the home the patient was using for allergy symptoms but not included in the ordered medications. These observations were reviewed with the RN and ADON.”