Every finding on record at Angels Hospice, LLC

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by an RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 6 of 10 (60%) clinical records reviewed in which aide services were accepted revealed the agency did not ensure specific written patient care instructions were provided for the hospice aides. Clinical Record 3: The patient elected the hospice benefit on 12/21/2023 for the diagnosis of coronary artery disease. The initial nursing assessment dated 12/21/2023 noted a "Stage II wound to the coccyx covered with a dry dressing." The aide care plan dated 12/21/2023 included the relevant tasks of bathing and dressing the patient. The aide care plan did not inform the aide of the wound or provide specific instructions for the aide to cover the wound dressing during bathing. Clinical Record 7: The patient elected the hospice benefit on 8/30/2023 for the diagnosis of pancreatic cancer. The initial nursing assessment dated 8/30/2023 noted the patient was on continuous oxygen at 2 liters per minute. The aide care plan dated 8/30/2023 included the relevant tasks of complete bed bath, shampoo and dress the patient. The aide care plan did not include specific instructions for the oxygen to include whether to remove or leave on during tasks. Clinical Record 9: The patient elected the hospice benefit on 8/7/2023 for the diagnosis of Alzheimer's disease. The initial nursing assessment dated 8/7/2023 noted a "Stage II dry wound to coccyx covered with a dry dressing". The aide care plan dated 8/7/2023 included the relevant tasks of bed bath and dressing the patient. The nursing assessment dated 8/22/2023 noted the patient was started on continuous oxygen at 4 liters per minute. The aide care plan did not inform the aide of the wound or provide specific instructions for the aide to cover the wound dressing during bathing. The aide care plan was not updated to inform the aide the patient was started on oxygen nor to provide instructions. Clinical Record 10: The patient elected the hospice benefit on 4/22/2023 for the diagnosis of breast cancer. The initial nursing assessment dated 4/22/2023 noted the patient had a foley catheter. The aide care plan dated 4/22/2023 included the relevant task of perineal care but did not inform the aide the patient had a foley catheter. Clinical Record 11: The patient elected the hospice benefit on 5/9/2023 for the diagnosis of adenocarcinoma of the right lung. The initial nursing assessment dated 5/9/2023 noted the patient was on continuous oxygen at 5 liters per minute. The aide care plan dated 5/9/2023 did not list the oxygen nor provide specific instructions for the aide. Clinical Record 12: The patient elected the hospice benefit on 3/21/2023 for the diagnosis of stroke. The nursing assessment dated 3/24/2023 noted the patient was on continuous oxygen at 2-4 liters per minute. The aide care plan dated 3/24/2023 did not list the oxygen nor provide specific instructions for the aide. A joint clinical record review and interview was conducted with the Administrator/DPCS on 1/10/2024. Administrator/DPCS agreed these items had not been included in the aide care plans.

It is required that a patient clinical record contains correct clinical information including physician orders. This standard was not met as evidenced by clinical record review and interview. In 14 of 14 (100%) clinical records reviewed clinical records reviewed revealed the agency did not ensure the physician orders contained all required elements. Clinical Record 1: The patient elected the hospice benefit on 11/25/2023 for the diagnosis of endometrial cancer. The initial physician admission order dated 11/25/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification and MSW 1-2x per month and 5 PRN per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 2: The patient elected the hospice benefit on 11/8/2023 for the diagnosis of end-stage renal disease. The initial physician admission order dated 11/8/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification.' The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 3: The patient elected the hospice benefit on 12/21/2023 for the diagnosis of coronary artery disease. The initial physician admission order dated 12/21/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 4: The patient elected the hospice benefit on 12/7/2023 for the diagnosis of Parkinson's disease. The initial physician admission order dated 12/7/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 5: The patient elected the hospice benefit on 12/12/2023 for the diagnosis of renal cell carcinoma. The initial physician admission order dated 12/12/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 6: The patient elected the hospice benefit on 11/26/2023 for the diagnosis of end-stage heart failure. The initial physician admission order dated 11/26/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification and MSW 1-2x month and 5 PRN per cert." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 7: The patient elected the hospice benefit on 8/30/2023 for the diagnosis of pancreatic cancer. The initial physician admission order dated 8/30/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 8: The patient elected the hospice benefit on 7/21/2023 for the diagnosis of chronic respiratory failure. The initial physician admission order dated 7/21/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 9: The patient elected the hospice benefit on 8/7/2023 for the diagnosis of Alzheimer's disease. The initial physician admission order dated 8/7/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 10: The patient elected the hospice benefit on 4/22/2023 for the diagnosis of breast cancer. The initial physician admission order dated 4/22/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 11: The patient elected the hospice benefit on 5/9/2023 for the diagnosis of adenocarcinoma of the right lung. The initial physician admission order dated 5/9/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 12: The patient elected the hospice benefit on 3/21/2023 for the diagnosis of stroke. The initial physician admission order dated 3/21/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 13: The patient elected the hospice benefit on 7/27/2023 for the diagnosis of chronic obstructive pulmonary disease. The initial physician admission order dated 7/27/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. Clinical Record 14: The patient elected the hospice benefit on 9/11/2023 for the diagnosis of pancreatic cancer. The initial physician admission order dated 9/11/2023 listed the frequency of visits as "Nurse frequency 1-2xwk & 15 PRN (as needed) per certification." The physician's order was incomplete as it did not specify an as-needed (PRN) reason. A joint clinical record review and interview was conducted on 1/10/2024 with the Administrator/DPCS. Administrator/DPCS agreed that the physician orders should have included as-needed (PRN) reasons.