Every finding on record at Advocare Hospice, Inc.

Observed in Record Review. In 1 of 10 patient records reviewed, During HV#2 record review it was noted on the medication profile the patient was prescribed insulin and three other oral antidiabetic medications. The initial RN assessment lacked an evaluation of the patient's diabetic status. This was discussed with the organization leadership.

Observed in Record Review. In 4 of 10 patient records reviewed, During HV#1 record review it was noted an order for Apixaban 2.5 mg twice a day. The POC lacked interventions related to S/S bleeding and bleeding precautions instruction to the pt./PCG. Also in HV#1 record review, GI goals were established on the POC without documented interventions to accomplish the goals. During HV#2 record review it was noted GI and skin integument system goals without interventions on the POC to accomplish the goals. There was lack of spiritual interventions on the POC with a frequency once a month visits. During RR#1 it was noted for the skin/integumentary section there were goals established without interventions to accomplish the goal. The patient was prescribed ASA 81 mg daily po without instruction added to the POC to assess S/S bleeding and instruction on bleeding precautions. During RR#3 it was noted a frequency of visits for the Spiritual Counselor (SC) on the POC however the POC lacked interventions for the SC. During RR#4 it was noted the MSW had a frequency of visits on the POC of 1x/month. The POC lacked psychosocial interventions. This was discussed with the organization leadership.

Observed in Record Review. In 2 of 10 patient records reviewed, During RR#1 it was noted an order for the volunteer one time plus PRN. The order lacked the number or reason for PRN visits. The patient is visited weekly by a volunteer. During RR#3 it was noted an order for the volunteer one time then PRN. The order lacked the reason or number for the PRN visits. This was discussed with the organization leadership.

Observed in Record Review. In 10 of 10 patient records reviewed, During HV#1-#3 and RR#1-#7 record reviews it was noted oxygen orders for different liter flows based on mild, moderate or severe shortness of breath. The order lacked the specific parameters to assess mild, moderate and severe shortness of breath. This was discussed with the organization leadership.

Observed in Record Review. In 4 of 10 patient records reviewed, During HV#2 record review it was noted on the POC summary orders, other an order for the family/PCG to check fingerstick blood glucose three times per day. The SN visit notes after the order was written lack documentation that the family is checking the patient's blood sugar three times per day and lacked documentation of any blood sugar readings. In addition in HV#2 record reivew it was noted an order for the chaplain to visit once a month. There was lack of documentation for a visit in August 2024 without a reason for the missed visit. During RR#3 it was noted a frequency of visits for the chaplain on the POC was 1x/month. There was documentation of one visit in July 2024 after the initial assessment for the last 4 months without a documented reason the frequency was not followed. During HV#3 record review it was noted the following goals and interventions: Patient`s blood sugar will be well-controlled and not developing any DKS or HHS during the next 14 days. Interventions: Follow lab orders as specified. Report results to MD. Instruct pt./pcg regarding new medication/treatment order and side effects. Monitor/assess effectiveness of current and new medication/treatment. The SN visit assessments from the SOC to present lacked documentation of diabetic assessments. This was discussed with the organization leadership.

Observed in Patient Home. In 2 of 3 home visits conducted, During HV#1 it was noted the SN, after cleaning the equipment used during the visit that included a stethoscope, digital BP machine, thermometer and pulse oximeter, did not adhere to the wet to dry contact time of 2 minutes per the manufacturer direction for disinfection. After wiping down the equipment, it was immediately placed in her bag. During HV#3 it was noted the SN did not adhere to the 2 minute wet to dry contact time for the product used to disinfect the vital sign equipment used. This was discussed with the organization leadership. Observed in Patient Home. In 1 of 3 home visits conducted, During HV#1 it was noted the SN missed multiple opportunities to disinfect her hands after her gloves were removed during the care provided to the patient. In addition, she entered her nursing bag without removing her gloves and performing hand hygiene. This was discussed with the organization leadership.

Observed in Record Review. In 2 of 8 patient records reviewed, who received hospice aide serivces. During RR#3 and RR#7 it was noted an order for oxygen therapy 2-5L PRN via NC for shortness of breath on the aide assignment POC. The direction to the aide lacked which liter flow to use if indicated. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 10 patient records reviewed, During RR#4 it was noted lack of documentation during two SN visits after a wound care specialist consult with physician orders for a specific wound care procedure to be performed during SN visits. The documentation lacked the components of the wound care order and stated wound care for a blister on the left lower extremity was performed. This was discussed with the organization leadership.

Observed in Record Review. In 1 of 2 patient records reviewed, who were discharged alive. During Live D/CRR#1 it was noted the patient was transferred to a hospital ED post fall. There was lack of documentation that the hospice provided the receiving facility with a copy of the hospice discharge summary and, if requested, a copy of the patient’s clinical record. This was discussed with the organization leadership. Observed in Record Review. In 1 of 2 patient records reviewed, who were discharged alive. During Live D/CRR#2 it was noted the discharge summary lacked documentation of notice to the attending physician of the availability of the discharge summary. This was discussed with the organization leadership.