Every finding on record at Adoration Home Health & Hospice Care East Tennessee

Based on policy review, medical record review and interview, the agency failed to clarify a DNR (Do Not Resuscitate) status for 1 patient (#11) out of 13 patients reviewed. The findings included: --- Review of the agencys policy "Advance Directives," revised 5/11/2020, revealed ";...The hospice recognizes that all adult persons have a fundamental right to make decisions relating to their own medical treatment, including the right to accept or refuse medical care...Upon admission, the clinician/technician will provide information regarding a patients right to make decisions concerning health care, which include the right to accept or refuse medical or surgical treatment, even if that treatment is life-sustaining..." Review of the agencys policy "Bill of Rights," revised 5/11/2024, revealed ";...Self-determination, which encompasses the right to make choices regarding life-sustaining treatment, including resuscitative services. The right of self-determination may be effectuated by an advanced directive..." Medical record review revealed Patient #11 was admitted to the agency on 7/05/2024 with diagnoses including Malignant Neoplasm of Left Lower Limb and Secondary Malignant Neoplasm of Right Lung. Medical record review of Patient #11s Tennessee Physician Orders for Scope of Treatment (POLST) dated 7/10/2024, revealed ";...this is a Physicians Order Sheet based on the medical conditions and wishes of the person identified. Any section not completed indicates full treatment for that action..." Continued review revealed the section regarding Cardiopulmonary Resuscitation (CPR) had not been completed by the patient. Further review revealed the patient initiated this POLST form and had not completed this section. Continued review revealed since section not filled out by the patient the patient was to receive CPR (Cardiopulmonary Resuscitation). Medical record review of the Hospice Certification and Plan of Care dated 7/05/2024 -10/02/2024 revealed the patient was a Do Not Resuscitate (DNR) and not to receive CPR (Full Code). Further review revealed the DNR status on the plan of care did not match with the POLST form which was completed by the patient. Medical record review of physicians orders dated 7/05/2024-7/16/2024 revealed no orders were obtained by the agency to change the patient's DNR status from DNR to Full Code status. Medical record review of a Client Coordination Note Report dated 7/16/2024 revealed the patient revoked his hospice benefit as the patient was ";...not ready for hospice..." During an interview on 8/7/2024 at 2:15 PM, the Executive Director confirmed the POLST form completed by the patient was not reflected on the patient's plan of care.

Based on agency policy review, medical record review and interview, the agency failed to implement a bowel regimen protocol for 1 patient (#1) who received opioids (pain medication) of 13 patients reviewed. --- The findings include: Review of the agency policy, ";Comprehensive Assessment," revised 2019 revealed ";...An assessment of the need for a bowel regimen when the patient has been prescribed opioids..." Review of the Physician Standing Orders showed patients prescribed opioids are to receive constipation medications. Medical record review revealed Patient #1 was admitted to the agency on 7/11/2024 with diagnoses including Cerebral Atherosclerosis, Vascular Dementia, and Depression. Medical record review of the Comprehensive Assessment and Plan of Care dated 7/11/2024, revealed "...Instruct Bowel Protocol..." Medical record review of a Physician Order dated 7/13/2024, showed Patient #1 had been ordered Morphine Concentrate (an opioid used to treat pain) 0.25 milliliters (ML) 100 milligrams (MG)/5 ML every 2 hours for pain or dyspnea (shortness of breath). Medical record review of the medication profile summary showed Patient #1 had not been ordered medications for constipation. During an interview on 8/7/2024 at 2:18 PM, the Executive Director confirmed the agency failed to follow the agency policy for Patient #1 who received opioids and had not been placed on a bowel regimen protocol for constipation.

Based on facility policy review, medical record review, and interview, the agency failed to notify the physician to obtain an order for a urinalysis (UA) for 1 patient (Patient #1) of 3 patients reviewed. The findings include: Review of the agency policy titled, "Identification, Prevention, And Treatment Of Secondary Symptoms," revised 5/11/2020, showed "...Symptom control is the foundation of good hospice care...Care will be directed t optimize the patient's comfort and dignity through appropriate treatment of secondary symptoms as well as aggressively managing thee symptoms...The hospice interdisciplinary group will use published standards of care in the treatment of patient symptoms...Interdisciplinary group members will report to the Case Manager symptoms they may observe that are changes or are new from the patient's comprehensive assessments...The Case Manager will receive any and all information and will notify the attending physician...Orders will be obtained as necessary..." Record review revealed Patient #1 was admitted to the agency on 1/14/2022 and discharged on 1/30/2022, she was readmitted on 1/31/2022 and discharged due to moving out of the service area on 3/3/2022 with diagnoses including Senile Degeneration of the Brain, Dementia With Behavioral Disturbance, Anxiety Disorder, Depression, Insomnia, Urinary Tract Infection, Dysuria, and Repeated falls. Review of Patient #1's coordination note dated 3/1/2022, showed "...CG [caregiver] asked for a UA to be done because PT [Patient] is getting agitated, fighting, pushing, being uncooperative which she does when she gets UTI reports CG. Will contact MD [Medical Doctor]..." Record review showed no documentation the physician had been notified of the caregiver's request for a UA to be obtained and no documentation of a physician's order to obtain a UA after the 3/1/2022 coordination note. During a telephone interview on 6/8/2022 at 9:37 AM, Registered Nurse (RN) #1 stated she did not remember if she called the Physician to obtain an order for a UA. She stated she would have documented if she had called the physician even if he did not order a UA. During an interview on 6/8/2022 at 12:55 PM, the Office Manager confirmed the reported symptoms of increased behaviors would have been considered a change that should have been reported to the MD. She confirmed the request for a UA should have been reported to the MD. During a telephone interview on 6/8/2022 at 1:51 PM, the MD stated he would expect the nurse to have called and reported the request for the UA. He stated he would have given the order for a UA to be obtained if the nurse had notified him of the caregiver's request.