Peacehealth Southwest Hospice

“Observed in Record Review. In 2 of 20 patient records reviewed, the organization failed to complete the comprehensive assessment no later than 5 calendar days after the election of hospice care. For example: on review of RRNHV#3 the initial spiritual assessment was not documented as completed until day 7. In RRNHV#6 there was no documentation that the initial spiritual assessment was completed within 5 calendar days of admission. There was documentation that the Chaplain had left a message for the patient family, yet no further documentation of why the assessment could not be completed within the required timeframe. This observation was reviewed with the organization Leadership.”

“Observed in Record Review. In 3 of 20 patient records reviewed, the organization failed to conduct a patient-specific comprehensive assessment and reassessment that identifies the patient’s need for hospice care and services. For example: on review of RRHV#3 there was no documentation of a wound assessment noted in the clinical record over the last 3 weeks visits with the last documented wound assessment being the 1st week of March. Further, during home observation there was reported new occurring odor to the wound yet no wound assessment was completed. Policy noted that wound assessment should be documented weekly and with changes in status. In RRNHV#6 there was documentation of changes in the wound and updated wound orders, yet no documented wound assessment for a 21 day period between March and April. In RRNHV#5 there was documentation of a surgical wound on admission with documentation of wound care provided, yet no documentation of a comprehensive wound assessment throughout the record. These observations were reviewed with the organization Leadership.”

“Observed in Record Review. In 6 of 20 patient records reviewed, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#2 the patient’s primary terminal diagnosis was Congestive Heart Failure with shortness of breath, yet there was no cardiac plan of care nor one that reflected the patient’s use of oxygen. In RRHV#3 the documentation noted a wound to the patients foot/toe yet the care plan for skin integrity only noted a sacral wound and there was no reflection of the wound to the patient’s foot. In RRNHV#2 the documentation noted patient issues with nausea and vomiting yet there was no care plan established to reflect the nausea and vomiting issues documented. In RRNHV#3 the patient was utilizing oxygen, had a colostomy and a g-tube yet they were not reflected in the care plans. Further, there was documentation of a hospital bed, oxygen, and a hoyer lift in the record, yet no DME listed on the plan of care. In RRNHV#4 the documentation noted issues with nausea and vomiting requiring alternating Zofran and Compazine to control but there was no care plan to reflect the issues with nausea. In RRNHV#5 the documentation noted an infection in January prior to replacing the peritoneal drain but no infection care plan opened to guide the care. These observations were reviewed with the organization leadership.”

“Observed in Record Review. In 9 of 20 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. For example: on review of RRHV#2 during the home visit the patient was using oxygen at 3 liters per minute per nasal cannula, yet there were no orders for oxygen noted on the plan of care. In RRNHV#1 there was documentation that the patient was using oxygen and a cough assist device, yet there were no orders for their utilization noted on the record. In RRNHV#4 the order for oxygen was incomplete simply stated 1-10 liters. The order did not include a route, frequency, nor did it include instructions on when to utilize what liter flow of oxygen. In RRNHV#6 the oxygen order did not include an indication as required. In RRNHV#5 the patient had documentation of a surgical wound with documentation of treatment, yet no physicians order for dressing changes to the site. Further the patient had a peritoneal drain, yet no physicians order for care to the drain site. There was an order noted to drain once a week yet no specifics such as who was perform the care. In RRNHV#3 the documentation noted the patient with a colostomy and a g-tube but no physicians orders for care of the colostomy or the g-tube and site. In RRNHV#4 there were orders for PRN laxatives senna and Bisacodyl yet no specific instruction of which medication to use for which situation. The patient was also ordered two PRN antiemetics Zofran and Compazine but no instructions on when to use which medication. In RRNHV#2 the was an order for Seroquel that stated take once as needed but no frequency beyond once. In RRNHV#7 the Tylenol and Naproxen lacked indication as required. Further there were no specific instructions to guide the user as to which medication to choose for what type of pain or situation. These observations were reviewed with the Organization Leadership.”

“Observed in Record Review. In 2 of 20 patient records reviewed, the organization failed to ensure the individualized plan of care was reviewed, revised and documented as frequently as the patient’s condition requires but no less frequently that every 15 days. For example: on review of RRHV#2 the plan of care noted massage therapy for the patient’s pain, however documentation in the record noted that massage therapy was discontinued per caregiver request in October. Discontinuing massage therapy was not updated in the plan of care as the massage therapy care plan remained and active care plan to date of survey. In RRNHV#5 the documentation noted that the peritoneal drain had to be replaced however there was no documentation that the care plan was reviewed and revised to reflect the change in the patient status. This observation was reviewed with the organization Leadership.”

“Observed in Record Review. In 2 of 20 patient records reviewed, the organization failed to conduct and document patient-specific comprehensive assessment for spiritual concerns or needs. For example: on review of RRNHV#6 there was documentation that spiritual assessment was delayed as the spiritual coordinator attempted to contact the patient family. Months later spiritual visits began directly with the patient, however there was no documentation that an initial spiritual assessment was conducted prior to beginning the routine visits. This observation was reviewed with the organization Leadership. Observed in Record Review. Example #2: During a review of the medical record for RRNHV#12, it was noted that the Chaplain member of the interdisciplinary team did not complete an initial spiritual assessment before starting Chaplain visits to the patient’s home. The Chaplain documented missed home visits during week 4, and week 8 of hospice services. The first completed home visit was documented during week 9 of services. This observation was reviewed with agency leadership. 
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“Observed in Record Review. In 4 of 15 patient records reviewed, where hospice aide services were elected, the organization failed to ensure registered nurse provide written patient care instructions for the hospice aide. For example: on review of RRHV#2 the patient was utilizing oxygen that the RN on home observation noted was being utilized continuously, yet there was no indication on the Aide plan of care instructions of oxygen precautions or how to handle oxygen during the patient’s bath. Similarly in RRHV#4 the patient was using oxygen during the home visit to observe the aide, the oxygen was removed and replaced, however there was no specification on the aide plan of care for oxygen precautions, nor whether the oxygen could be safely removed for bathing. In RRNHV#3 the patient had a colostomy and a g-tube yet there were no instructions for the aide on how to handle these devices while carrying out the aide’s assigned tasks. In RRNHV#5 the patient had a peritoneal drain and a wound but no instruction to guide the aide on how to handle to drain and wound while providing care. These observations were reviewed with the organization Leadership.”

“Observed in Patient Home. In 1 of 6 home visits conducted, the organization failed to ensure the patient record contain all information that reflects the patient’s care, treatment and services. For example: On home observation for RRHV#2 during medication reconciliation there RN noted that the patient was using Tylenol as needed yet the order on the medication profile noted to be taken scheduled 2 times a day and an additional as needed order. In discussion with the RN and caregiver the patient had not been taking the scheduled Tylenol for an extended period of time since prior to the last comprehensive assessment. Further the medication profile noted senna twice daily yet the caregiver confirmed the patient had not been taking the laxative and asked should she be taking Senna? These observations were reviewed with the Nurse Manager.”

“Observed in Building Tour. During the review of the above ceiling area in hallway #1 of the Hospice Inpatient Building Longview, it was noted that the piping for the automatic sprinkler system was supporting other items – gray cords were resting on this piping. In hallway #2 of the Hospice Inpatient Building Longview, it was noted that gray cords and a coiled conduit was resting on this piping. This observation was reviewed with agency leadership. 
 This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission. Observed in Building Tour. The facilities personnel confirmed a penetration in the ceiling of the IPU mechanical room around AC refrigerant lines and pipe. This finding was observed during survey activity, but corrected onsite prior to the surveyor’s departure. The corrective action taken needs to be included in the organization’s Evidence of Standards Compliance submission.”

“Observed in Building Tour. The IPU nurse manager confirmed that they had not been checking the food served to patients to ensure proper cold or hot temperatures. The patient food temperature log found in the kitchen had been altered to be a family room soup pot temperature log. The log stated that hot food should be >165-180, but it was consistently documented >180. No follow up actions were documented when the temperature was out of range as stated on the log. Cold food serving temperatures for patients had not been monitored. Per policy, Dietary Department Hygiene and Sanitation, Cold food is held at 41 degrees or colder, and is checked with a metal stick thermometer. Hot food is held at 140 degrees or hotter, and is checked with a metal stick thermometer.”