Every finding on record at Alexian Brothers Medical Center

Observed in Record Review. In 1 of 2 Live discharge records, it was noted the organization failed to ensure that the patient was informed in advance about the expected outcomes of care and services. For example, in HosRRDC#1 the patient was discharged from hospice services due to patient no longer terminally ill. The Notification of Medicare Non-Coverage (NOMNC) was not found in the clinical record. Upon follow-up, the Hospice Director reported that the Medical Social Worker (MSW) confirmed she had not issued the NOMNC to the patient.

Observed in Patient Home. In 1 of 6 home visits conducted, it was noted that the organization failed to ensure that each patient and the primary caregiver receive education and training as appropriate to their responsibilities for the care and services identified in the plan of care. for example, in HosRRHV#4, patient was discharged to home with a nephrostomy tube in place. The hospice care plan included caregiver education on nephrostomy tube management, including instructions to flush the tube with 5 ml of normal saline solution only where is no drainage flow. During an interview, the patient's wife, who is the primary caregiver, reported that she has been flushing the tube with 10 ml of normal saline, stating this was the instruction provided by the hospital at discharge. When the hospice surveyor inquired about any follow up education or training provided to the caregiver regarding nephrostomy tube care, the hospice nurse did not provide a response. This finding was discussed with and validated by the Hospice Director who was present during the visit.

Observed in Record Review. In 1 of 18 active patient records reviewed, it was noted the organization failed to ensure that the written plan of care specify the hospice care and services necessary to meet the patient and family-specific identified in the comprehensive assessment. For example in HosRRNHV#9, based on review of the hospice plan of care (POC), the hospice nurse was ordered to provide instruction on nephrostomy tube management, including flushing with 5 ml of normal saline if there is no drainage flow, and performing dressing changes and site care every week and as needed (PRN). However, the order was found to be incomplete, as it did not specify the type of cleaning solution to be used or the clinical indication for PRN dressing changes. This finding was discussed and validated by the Hospice Director and Clinical Manager.

Observed in Patient Home. In 3 of 18 active patient' records, it was noted the organization failed to ensure that the hospice aide provides services that are ordered by the physician or allowed practitioner in the plan of care, consistent with the aide’s training, and that the aide is permitted to perform under state law. For example in HosRRHV#6, according to the aide care plan, the hospice aide was instructed to provide hair shampoo once a month. However, during the interview, the hospice aide reported that she has been shampooing the patient's hair on a weekly basis. In HosRRNHV#8, the Aide was instructed to provide shampooing for the patient once a week, however, it has been performed twice a week instead. In HosRRNHV#9, the hospice aide did not provide hair shampoo on six separate occasions, documenting each time that shampooing was not required this visit per frequency. However, the aide care plan specifies that hair shampoo was to be provided weekly. The ordered aide visit frequency was 1 visit per week for 13 weeks (1wk13). This finding was discussed with and validated by the Hospice Director who was present during home visit.

Observed in Record Review. In 1 of 18 active patient records reviewed, with hospice aide services, it was noted the organization failed to ensure that hospice aide supervision was conducted no less than every 14 days as required. During review of record HosRRNHV#9 documentation, showed a gap of 36 days between the third week of March and second week of April. This finding was discussed and validated by the Hospice Director.

Observed in Record Review. In 5 of 16 patient records reviewed, The hospice nurse surveyor noted (HOSV#3) that the medical social worker assessment was not completed until eight days after admission. The surveyor noted that the record indicated that the first contact by the social worker was not completed until day seven and there was no indication that the patient had refused the service. Also, in (ARR#4), the social worker did not contact the patient until day six and the assessment was not completed until day seven. In (ARR#5), the social work assessment was not completed until day six and in (ARR#6) the social work assessment was not completed until day seven. This was confirmed with the hospice manager.

Observed in Record Review. In 2 of 16 patient records reviewed, The hospice nurse surveyor noted (ARR#2) that the nursing assessment indicated that the patient was experiencing dyspnea; however, there was no assessment of the severity. In (ARR#6), the nursing assessment indicated that the patient had symptoms of dyspnea, nausea and vomiting, and constipation; however there was no assessment of the severity of the symptoms. Also, the pain assessment indicated that the patient had pain in five locations-abdomen, hip, both legs and head; however, the pain scale was rated for all locations and did not specify the severity of each pain location. This was confirmed with the hospice manager.

Observed in Individual Tracer. In 3 of 16 patient records reviewed, The hospice nurse surveyor noted (HOSV#2) that the patient was on continuous oxygen and that the dose was increased from 5 LPM to 6 LPM. The surveyor noted that the plan of care did not include a measurable outcome for managing the patient's dyspnea symptom. Also, the surveyor noted that the nurse disconnected the concentrator when the patient was moved from the living area to her room. She was without oxygen for approximately two minutes and her dyspnea increased. The nurse indicated that the assisted facility nurse did not allow extension tubing and the plan of care did not address the need to seek an alternative for maintaining the continuous oxygen. In (ARR#4), there were no outcome measures to manage the patient's dyspnea and in (ARR#5), the plan of care goals did not include any measurable outcomes. This was confirmed with the hospice manager.

Observed in Individual Tracer. In 3 of 16 patient records reviewed, The hospice nurse surveyor noted (HOSV#3) that there were oxygen tanks in the home and the visit notes indicated that the patient had been ordered oxygen; however, there was no oxygen order on file. In (ARR#1), the surveyor noted that there was no order for peripheral intravenous insertion. In (ARR#6), the surveyor noted that the medication orders for Ondansetron and Senna did not include a frequency for PRN dosing. This was confirmed with the hospice manager.

Observed in Individual Tracer. In 2 of 16 patient records reviewed, The hospice nurse surveyor noted (HOSV#4) that the goals were not updated with needs identified in assessment. For example, the assessment indicated that the patient was experiencing constipation with bowel movement only every 5-7 days, night time anxiety with periods of sun-downing and was at risk for aspiration; however these issues were not addressed in the recertification plan of care. In (DRR#3), the plan of care was not updated and did not reflect the patients progress toward goals. The surveyor noted that the patient was admitted and assessed for pain, anxiety, edema and poor nutrition. The patient was discharge from hospice and transferred to palliative care; however the plan of care and interdisciplinary team meeting notes did not reflect the patient's progress toward goals and symptom management. This was confirmed with hospice manager.

Observed in Individual Tracer. In 1 of 4 home visits conducted, The hospice nurse surveyor noted (HOSV#4) that the nurse used Cavi-wipes to clean the equipment; however, she only wiped the equipment down and did not maintain it wet for three minutes as required by manufacturer's guidelines. She left the blood pressure cuff, thermometer and pulse oximeter to dry for a minute before returning it to her bag. This was confirmed with the nurse manager.

Observed in HR File Review. In 3 of 8 HR files reviewed, The hospice nurse surveyor noted that there was no evidence in the personnel files of a hospice Chaplain, a social worker and the Medical Director that a skills competency had been performed in the last three years or since they were hired. This was confirmed with the hospice manager.

Observed in Individual Tracer. In 2 of 4 home visits conducted, The hospice nurse surveyor noted (HOSV#1) that the aide removed the patient's oxygen when providing her bath. The surveyor noted that the aide plan of care did not include instructions for managing the oxygen. Also, the patient had a Vaseline gauze bandage in place that covered 1/3 of the patients scalp; however there were no instructions or precautions on the care plan regarding shampooing the patient's head with the dressing in place. The surveyor also noted in (HOSV#2) that the patient was on continuous oxygen; however, the aide plan of care did not include instructions about the oxygen when bathing the patient. This was confirmed with the hospice manager.

Observed in Individual Tracer. In 1 of 16 patient records reviewed, The hospice nurse surveyor noted (HV#1) that the consent form obtained in March was not signed. The surveyor confirmed with the hospice manager that the signed consent had been obtained by the medical social worker; however, it was never filed into the record.

Observed in Record Review. During review of record for revocation there was not documentation that the transfer summary was provided to the Skilled Nursing Facility where the patient was admitted for aggressive treatment. This finding was discussed and verified with Hospice Manager. Observed in Record Review. During review of record for revocation there was not documentation that the transfer summary was provided to the hospital where the patient was admitted for aggressive treatment. This finding was discussed and verified with Hospice Manager. Observed in Record Review. In 4 of 4 discharge records reviewed, The hospice nurse surveyor noted (DRR#3) that there was no evidence in the record that information was provided to the next provider or physician when the patient was discharged from hospice and referred to palliative care. The surveyor noted that the visit notes prior to discharge indicated that the patient was experiencing ongoing issues with managing symptoms of anxiety and that the caregiver was expressing suicidal thoughts. There was no evidence that this information was provided to the palliative program upon referral or that the physician was notified in the discharge summary. Also, in (DRR#4), the patient was discharged from the hospice residence and care was transferred to home health services. There was no evidence in the record that a summary of care was provided to the home heath agency. This was confirmed with the hospice manager.