Hospice of the Shenandoah

“Observed in Record Review. In 14 of 14 patient records reviewed, for all active records, the nurse surveyor noted that the goals were not measurable or individualized, for example, Patient will see effective management of pain and other distressing symptoms as measured by patient reported satisfaction within two weeks”, “ Patient will see improved comfort relating to gastrointestinal symptoms as illustrated by subjective patient or caregiver reporting by end of current benefit period” and “ Patient will see a comfortable and peaceful care environment as demonstrated by family/caregiver reported satisfaction in three weeks”. Findings were discussed with the Administrator/ DON, and the CEO.”

“Observed in Record Review. In 2 of 14 patient records reviewed, it was noted by the nurse surveyor that the plan of care did not include all necessary services for patient care, medication orders were unclear. For HOSRRHV#2, the patient had an intermittent draining abscess for which care was being provided by the skilled nurse and assisted living facility staff. The care plan did not include orders for the care being provided. For HOSRRNHV#1, there was an order for Lidocaine external, apply quarter size cream, external twice a day for pain. There was no indication where the medication was to be applied. Findings were discussed with the COO/DON.”

“Observed in Record Review. In 4 of 14 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For HOSRRHV#2, HOSRRHV#3, and HOSRRHV#4, the patients all had oxygen ordered PRN yet there were not instructions for the aide if the patient should have the oxygen on, could it be removed. For HOSRRNHV#1, the patient had a foley catheter, and skin breakdown, yet the hospice aide care plan did not mention or address what the hospice aide’s responsibility should be in response to these. Findings were discussed and verified with the COO/DON.”

“Observed in Record Review. In 2 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that the medication profile was inaccurate in the electronic medical record (EMR). For HOSRRHV#1, there were duplicate orders for Calcium Antacid Chewable 500mg, 2 daily (taken as supplement) and Calcium Carbonate Tablet Chewable 1250 (500 Calcium), two tabs daily and for Cranberry Concentrate Cap 500, 1 capsule po daily and Cranberry tablet 500mg one tablet daily. For HOSRRNHV#1, There was a duplicate order for Cephalexin 500 one tablet bid daily and Cephalexin Capsule 500mg one capsule po bid and Allopurinol 300mg one daily was listed twice. Findings were discussed and verified by the COO/DON.”

“Upon patient record review, 3 of 21 (Patient #1, #2, #3) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient #1-On 03/15/24 the nurse documents the patient is taking Tylenol for pain. Tylenol is not listed on the medication profile. (corrected on site). Patient #2-On 02/18/24 the nurse documents the patient is taking Tylenol for fever. Tylenol is not listed on the medication profile. Erythromycin 5mg/g (0.5%) 1/2 inch tid eye ointment is listed on the profile. The profile does not specify which eye(s) for administration. (corrected on site). Patient #3- Miralax 17gm powder 1 packet daily prn for constipation is listed on the profile without a diluent. (corrected on site)”

“Upon patient record review, 4 of 21 (Patient #2, #3, #7, #12) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2- Erythromycin 5mg/g (0.5%) 1/2 inch tid eye ointment is listed on the plan of care. The plan of care does not specify which eye(s) for administration. (corrected on site). Patient #3- Miralax 17gm powder 1 packet daily prn for constipation is listed on the plan of care without a diluent. (corrected on site) Patient #7-The 03/11/24 plan of care includes orders for the nurse to teach the patient management of the Foley and Foley to be flushed three times weekly per protocol. The orders do not address catheter size, balloon size, frequency to be changed and specific flush and amount to be utilized. (corrected on site) Patient #12-The orders on 03/19/24 to update the plan of care read: Insert Foley catheter. The orders are not specific for size, balloon size and indications for changes. (corrected on site)”

“Upon patient record review, 1 of 21 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1-Orders were received on 03/03/24 for the nurse to visit weekly to perform wound care to the L buttocks with wound cleanser, apply skin prep around wound and Exuderm dressing. The plan of care also includes orders to assess the wound for healing weekly. Between 03/01/24 and 03/15/24 the nursing documentation indicates the wound care was provided weekly on 3/05/24 and 03/12/24; however the documentation does not include a wound description or measurements. (late entry correction on site )”