Every finding on record at Adventhealth Hospice Care Porter

Observed in Record Review. In 1 of 13 patient records reviewed, the organization did not ensure the plan of care included all required information. For example, a review of the medical record for HosRR#6, revealed that the patient experienced a fall during week 4 of services. The plan of care was not updated with interventions to maintain patient safety, and strategies to prevent injury. This observation was reviewed with the Director of Hospice.

Observed in Building Tour. The surveyor observed that the piping for approved automatic sprinkler systems was supporting other items. For example, in the above ceiling area of hallway #1 and hallway #2 there were multiple cords resting on the sprinkler pipe(s). This observation was reviewed with the Facilities Manager. 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.

Based on interview and record review, the hospice failed to ensure services furnished were in accordance with the plan of care (POC) established by the interdisciplinary group (IDG) and in collaboration with the attending physician for 1 of 3 discharged patient records reviewed (Patient #1). Findings include: AGENCY POLICY According to the policy titled, "Plan of care (HC/Hospice)", dated 9/15/17, in part: "Purpose 1. To ensure care provided to patients is physician directed and individualized based on patient health care needs, and that the plan of care reflects the individualized visit frequency, interventions and measurable goals necessary to provide that care." 1. The clinical record for Patient #1 was reviewed on 12/7/21. The patient was admitted to hospice care on 3/30/21 with a terminal diagnosis of chronic obstructive pulmonary disease requiring continuous supplemental oxygen. The POC for the certification period, dated 3/30/21 to 6/3/21, included orders for inpatient hospice beginning 5/30/21. During the inpatient hospice stay physician orders included skilled nursing (SN) visits continuously and for routine monitoring of oxygen saturation using pulse oximetry measurements for signs or symptoms of anxiety, dyspnea or changes in level of consciousness. a) The agency failed to ensure services furnished to Patient #1 were in accordance with the POC and collaborated with the attending physician. Review of Patient #1's records during inpatient hospice stay dated 5/30/21 to 6/3/21 revealed RN #9 documented on 5/31/21 at 4:03 a.m. revealed Patient #1 experienced severe shortness of breath with movement that night, however, RN #9 did not document monitoring the patient's oxygen saturation. Further review of documentation dated 5/31/21 at 10:30 a.m. revealed Patient #1 had increased dyspnea and the family made RN #5 aware that oxygen flow appeared low. RN #5 then noted the oxygen tubing was not threaded correctly allowing an air leak. She documented she adjusted the oxygen tubing which assured flow increased; however, RN #5 failed to monitor oxygen saturation at this time. On 5/31/21 at 11:30 a.m., RN #5 documented that Patient #1 had become somnolent but she failed to document if oxygen saturation had been monitored. Review of inpatient hospice records revealed RN #10 had documented on 6/1/21 Patient #1 received morphine for respiratory comfort and this was increased due to an increased need as well as that patient respirations were shallow, however, oxygen saturation was not monitored this date. Review of records completed on 6/2/21 revealed RN #5 documented at 2:39 p.m. Patient #1 had a respiratory rate of 28 and at 3:30 p.m. a respiratory rate of 20, however, oxygen saturation was not documented as monitored. RN #11 documented on 6/3/21 that Patient #1's respiratory rate continued at 20 at 4:57 p.m., however, oxygen saturation was not documented as monitored. During an interview on 12/8/21 at 2:09 p.m., RN #5 stated that at the time family noted concern regarding oxygen leak to Patient #1 on 5/31/21, oxygen saturation should have been checked and should have been checked again when Patient #1 was noted to have become somnolent. RN #5 stated physician was called regarding changes in patient condition, however, she was unsure if oxygen concern was reported to the physician. RN #5 confirmed that if documentation did not reveal oxygen saturation was monitored then it was not completed. During an interview on 12/8/21 at 2:19 p.m., the administrator stated the agency's expectation was that RN corrects oxygen concerns and notify inpatient charge nurse as well as either patient or family about found concern, intervention and monitoring.

Based on interview and record review, the hospice failed to ensure the interdisciplinary group (IDG), in collaboration with the attending physician, reviewed, revised and documented the plan of care (POC) as frequently as the patient's condition required, but no less than every 15 days for 1 of 6 active patient records reviewed (Patient #2). Findings include: AGENCY POLICY According to a policy titled, "Plan of Care (HC/Hospice)", dated 9/15/17, in part: "The Plan of Care shall be reviewed, evaluated, and revised (minimally every sixty (60) days for home care no less than every 15 days for hospice and as needed)..." 1. During an interview on 12/6/21 at 9:50 a.m., the administrator reported that IDG meetings were completed every two weeks and the plan of care was updated and reviewed by all core IDG members at these meetings. 2. The clinical record for Patient #2 was reviewed on 2/7/21. The patient was admitted to hospice care on 4/18/20 with a terminal diagnosis of hypertensive heart and renal disease with heart failure. The plans of care for the certification periods dated 10/10/21 to 12/8/21 and 12/9/21 to 2/6/22 included orders for skilled nursing (SN) visits one time per week with five visits as needed (PRN), medical social work (MSW) visits one time per month, chaplain (CH) visits one to two times per month; and home health aide (HHA) visits twice weekly for nine weeks. a) The agency failed to ensure Patient #2's POC was updated no less frequently than every 15 days. Review of completed IDG notes and POCs for Patient #2 between 9/1/21 to 12/7/21 revealed the POC was updated and reviewed by IDG on 10/21/21; however, the next documented IDG meeting was 11/15/21. There was no documentation to show Patient #2's plan of care was reviewed by the IDG between 11/1/21 and 11/5/21, a period of 25 days. Further, review of December IDG notes revealed IDG members completed updates to the POC in anticipation of a meeting; however, documentation failed to reveal the IDG members present and on what date this IDG meeting occurred. During an interview on 12/8/21 at approximately 1:45 p.m., the administrator reviewed IDG meeting notes and POC updates between 11/1/21 and 11/5/21. Following review, she confirmed IDG meetings could not be confirmed as completed no less frequently than every 15 days in accordance with the regulation. She further stated additional education regarding the importance of IDG meeting frequency will be provided to the employee who coordinated the IDG meetings.