Every finding on record at Baptist Health

Based on clinical record review and staff interview it was determined the Agency failed to develop an individualized Plan of Care (POC) which included patient specific scope and frequency of visits to be made by the Hospice Chaplain and the Medical Social Worker in 14 (#1-#14) of 14 (#1 - #14) clinical records reviewed. This failed practice had the potential to affect all patients and/or families on current census in obtaining relief from spiritual and/or emotional conflict to promote the hospice patients well-being, comfort, and dignity throughout the dying process. Findings follow: --- 1. Review of clinical record #1 with a SOC (start of care) of 04/17/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. Review of a document titled ";Hospice Plan of Care Update 06/23/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 4/20/2023 to 7/15/2023 and Medical Social Work visits 3 visits as needed with effective dates from 4/17/2023 to 7/15/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 2. Review of clinical record #2 with a SOC of 06/13/22 revealed a patient with a diagnosis of Malignant Neoplasm of Frontal Lobe of the Brain. Review of a document titled "Hospice Plan of Care Update 06/23/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 6/14/2023 to 9/10/2023 and Medical Social Work visits 3 visits as needed with effective dates from 6/13/2023 to 9/10/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 3. Review of clinical record #3 with a SOC of 05/02/23 revealed a patient with a diagnosis of Cerebrovascular Accident. Review of a document titled "Hospice Plan of Care Update 06/09/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 5/4/2023 to 7/30/2023 and Medical Social Work visits 3 visits as needed with effective dates from 5/2/2023 to 7/30/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 4. Review of clinical record #4 with a SOC of 09/15/22 revealed a patient with a diagnosis of Chronic Obstructive Pulmonary Disease. Review of a document titled "Plan of Care 1- Update B" revealed orders for Chaplain visits 4 visits as needed with effective dates from 9/16/2022 to 12/13/2022 and Medical Social Work visits 3 visits as needed with effective dates from 9/15/2022 to 12/13/2022. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 5. Review of clinical record #5 with a SOC of 05/25/23 revealed a patient with a diagnosis of Chronic Obstructive Pulmonary Disease. Review of a document titled "Hospice Plan of Care Update 06/09/23" revealed orders for Chaplain visits 5 visits as needed with effective dates from 5/25/2023 to 8/22/2023 and Medical Social Work visits 3 visits as needed with effective dates from 5/25/2023 to 8/22/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 6. Review of clinical record #6 with a SOC of 12/30/22 revealed a patient with a diagnosis of Peripheral Artery Disease. Review of a document titled "Hospice Plan of Care Update 06/09/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 3/30/23 to 6/27/2023 and Medical Social Work visits 3 visits as needed with effective dates from 3/30/2023 to 6/27/23. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 7. Review of clinical record #7 with a SOC of 06/05/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. Review of a document titled "Hospice Plan of Care Update 06/23/23" revealed orders for Chaplain visits 5 visits as needed with effective dates from 5/7/2023 to 9/2/2023 and Medical Social Work visits 3 visits as needed with effective dates from 6/5/2023 to 9/2/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 8. Review of clinical record #8 with a SOC of 04/14/23 revealed a patient with a diagnosis of Hypertensive Heart & Renal Disease with Heart Failure. Review of a document titled ";Hospice Plan of Care Update 6/23/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 4/15/2023 to 7/12/2023 and Medical Social Worker visits 3 visits as needed with effective dates from 4/14/2023 to 7/12/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 9. Review of clinical record #9 with a SOC of 06/12/23 revealed a patient with a diagnosis of Malignant Neoplasm of Upper Lobe of Right Lung. Review of a document titled "Hospice Plan of Care 06/12/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 6/14/2023 to 9/9/2023 and Medical Social Work visits 3 visits as needed with effective dates from 6/12/2023 to 9/9/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 10. Review of clinical record #10 with a SOC of 05/09/23 revealed a patient with a diagnosis of Alzheimers. Review of a document titled ";Hospice Plan of Care Update 06/23/23" revealed orders for Chaplain visits 5 visits as needed with effective dates from 5/12/2023 to 8/6/2023 and Medical Social Work visits 3 visits as needed with effective dates from 5/9/2023 to 8/6/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 11. Review of clinical record #11 with a SOC of 01/11/22 revealed a patient with a diagnosis of Cerebrovascular Accident. Review of a document titled ";Hospice Plan of Care Update 06/23/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 05/06/2023 to 07/04/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 12. Review of clinical record #12 with a SOC of 03/15/23 revealed a patient with a diagnosis of Primary Malignant Neoplasm of Right Lung. Review of a document titled ";Hospice Plan of Care Update 03/31/23" revealed orders for Chaplain visits 4 visits as needed with effective dates from 3/17/2023 to 6/12/2023 and Medical Social Work visits 3 visits as needed with effective dates from 3/15/2023 to 6/12/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 13. Review of clinical record #13 with a SOC of 02/16/23 revealed a patient with a diagnosis of Malignant Neoplasm of Ovary. Review of a document titled ";Hospice Plan of Care Update 03/17/23". revealed orders for Chaplain visits 5 visits as needed with effective dates from 2/21/2023 to 5/16/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 14. Review of clinical record #14 with a SOC of 12/10/22 revealed a patient with a diagnosis of Oropharyngeal Dysphagia. Review of a document titled "Hospice Plan of Care Update 12/10/22" revealed orders for Chaplain visits 4 visits as needed with effective dates from 12/13/2022 to 3/9/2023 and Medical Social Work visits 5 visits as needed with effective dates from 12/10/2022 to 3/9/2023. There were no specific or individualized orders for scope and frequency of visits for Chaplain or Medical Social Worker visits. 15. An interview was conducted on 06/28/23 at 11:00 AM with Personnel #3 regarding orders for visit frequency. Questioned how the frequency of the Chaplains visits are determined. Reports discusses with the patient and family on the initial visit. States normally visits are made every 2-4 weeks depending upon the patients needs and request. 16. An interview on 06/30/23 with Agency Personnel #1 confirmed the lack of specific and individualized orders for the Chaplain and Medical Social Worker visit frequency.

Based on clinical record review and staff interview, it was determined the Registered Nurse (RN) failed to follow the written plan of care in 6 (#4, #6, #8, #10, #11, and #12) of 14 (#1-#14) clinical records reviewed. This failed practice had the potential to affect all patients on current census and placed the patients and/or families at risk for adverse outcomes, ineffective care, and services due to a delay in coordination of information to meet the patients needs. The findings are as follow: --- Review of clinical record #4 with a SOC of 09/15/22 revealed a patient with a diagnosis of Chronic Obstructive Pulmonary Disease. Review of a document titled "Plan of Care 1- Update B" revealed orders for skilled nurse (SN) visits 1 visit every 2 weeks for 13 weeks with effective dates from 9/18/2022 to 12/13/2022. SN visits missed 09/18/22-10/01/22 and 10/23/22-11/05/22. Review of clinical record #6 with a SOC of 12/30/22 revealed a patient with a diagnosis of Peripheral Artery Disease. Review of a document titled "Hospice Plan of Care Update 06/09/23" revealed orders for SN visits 1 visit every week for 13 weeks with effective dates from 3/30/23 to 6/27/23. SN visits missed 05/07/23-05/13/23. Review of clinical record #8 with a SOC of 04/14/23 revealed a patient with a diagnosis of Hypertensive Heart & Renal Disease with Heart Failure. Review of a document titled ";Hospice Plan of Care Update 6/23/23" revealed orders for SN visits 1 visit every week for 12 weeks with effective dates from 4/17/2023 to 7/8/2023. SN visits missed04/23/23-04/29/23, 06/11/23-06/17/23, and 06/18/23-06/24/23. Review of clinical record #10 with a SOC of 05/09/23 revealed a patient with a diagnosis of Alzheimers. Review of a document titled ";Hospice Plan of Care Update 06/23/23" revealed orders for SN visits 1 visit every week for 12 weeks with effective dates from 5/14/2023 to 8/5/2023. SN visits missed 06/18/23-06/24/23. Review of clinical record #11 with a SOC of 01/11/22 revealed a patient with a diagnosis of Cerebrovascular Accident. Review of a document titled ";Hospice Plan of Care Update 06/23/23" revealed orders for SN visits 1 visit every week for 8 weeks with effective dates from 5/7/2023 to 7/1/2023. SN visits missed 06/04/23-06/10/23. Review of clinical record #12 with a SOC of 03/15/23 revealed a patient with a diagnosis of Primary Malignant Neoplasm of Right Lung. Review of a document titled ";Hospice Plan of Care Update 03/31/23" revealed orders for SN visits 1 visit every week for 13 weeks with effective dates from 3/15/2023 to 6/10/2023. SN visits missed 04/09/23-04/15/23. An interview on 06/29/23 with Agency Personnel #2 confirmed the missed SN visits.

Based on clinical record review, staff interview, and patient interview it was determined the Agency did not utilize the Medical Social Worker (MSW) as part of the Interdisciplinary Group (IDG) in 14 (#1 - #14) of 14 (#1 - #14) clinical records reviewed. The absence of the MSW participation had the potential to affect all patients and/or families on current census in that coping mechanisms of the patient and family may be inadequate, family dynamic needs may not be met, caregivers function may be adversely affected, family support systems may be challenged which may limit the hospice staff from providing emotional support, social support, and ancillary resources for the patient and/or family. Findings follow: --- Review of clinical record #1 with a SOC (start of care) of 04/17/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. Review of a document dated 4/21/2023 and titled ";MSW Missed Visit Notes" revealed a communication note with ";Communication details: MSW contaxcted [contacted] pts niece Diane by phone to schedule assessment visit. Daughter stated that she usually works during the daytime hours. She reported that pt has paid care givers with her in the home 24 hours per day. Care giver during the day during the week is named Pat. Pt has had a steady and progressive decline in her condition over the past 6 years. Pt is forgetful and has trouble with short term memory. Family is understanding and accepting of pts condition and prognosis. Diane declined need for MSW services or support at this time. MSW provided information about role of hospice social worker, as well as contact information for MSW. MSW remains available for additional assistance or support as needed". There was no evidence to indicate the psychosocial assessment had been completed or included in the development of the Initial Comprehensive Assessment or any other involvement by the MSW in the patients care. Review of clinical record #2 with a SOC of 06/13/22 revealed a patient with a diagnosis of Malignant Neoplasm of Frontal Lobe of the Brain. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 06/22/23 Review of clinical record #3 with a SOC of 05/02/23 revealed a patient with a diagnosis of Cerebrovascular Accident. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 05/03/23. Review of clinical record #4 with a SOC of 09/15/22 revealed a patient with a diagnosis of Chronic Obstructive Pulmonary Disease. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 09/20/22. Review of clinical record #5 with a SOC of 05/25/23 revealed a patient with a diagnosis of Chronic Obstructive Pulmonary Disease. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 05/26/23. Review of clinical record #6 with a SOC of 12/30/22 revealed a patient with a diagnosis of Peripheral Artery Disease. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on SOC 12/30/22 to patients death 06/28/23. Review of clinical record #7 with a SOC of 06/05/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 06/07/23. Review of clinical record #8 with a SOC of 04/14/23 revealed a patient with a diagnosis of Hypertensive Heart & Renal Disease with Heart Failure. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 04/19/23. Review of clinical record #9 with a SOC of 06/12/23 revealed a patient with a diagnosis of Malignant Neoplasm of Upper Lobe of Right Lung. Review of a document dated 6/15/2023 and titled ";MSW Missed Visit Notes" revealed a communication note with ";Communication details: MSW attempted to contact pts husband to schedule assessment visit. Husband did not answer MSWs call. MSW left voicemail message requesting a return call. Call has not been returned as of this time. MSW remains available for additional assistance or support as needed." An interview was conducted on 06/29/23 at 1:00 PM in the patient's home with patient #9 and her adult daughter. Asked if they were agreeable to a visit by the MSW, and if they had been contacted by the MSW to schedule a visit. Both were agreeable to contact and/or visits by the MSW and were not aware of any attempts to schedule a visit. When told the MSW documented she attempted to call the husbands phone and left a message, the patient said, ";He dont answer it (phone) half the time" and the daughter laughed and said, ";Im pretty sure he doesnt even know how to check voicemail." There was no evidence to indicate the psychosocial assessment had been completed or included in the development of the Initial Comprehensive Assessment or any other involvement by the MSW in the patients care. Review of clinical record #10 with a SOC of 05/09/23 revealed a patient with a diagnosis of Alzheimers. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 05/15/23. Review of clinical record #11 with a SOC of 01/11/22 revealed a patient with a diagnosis of Cerebrovascular Accident. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 01/19/22 and a returned call to the patients wife 07/08/22 who called requesting information regarding Respite services. Review of clinical record #12 with a SOC of 03/15/23 revealed a patient with a diagnosis of Primary Malignant Neoplasm of Right Lung. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 03/22/23. Review of clinical record #13 with a SOC of 02/16/23 revealed a patient with a diagnosis of Malignant Neoplasm of Ovary. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 02/17/23. Review of clinical record #14 with a SOC of 12/10/22 revealed a patient with a diagnosis of Oropharyngeal Dysphagia. There was no evidence of the MSW involvement in the Patient's care other than the Initial Psychosocial Assessment completed on 12/15/22. An interview on 06/30/23 with Agency Personnel #1 confirmed the lack of MSW involvement in patients care other than the initial psychosocial assessment.

Based on clinical record review and staff interview, it was determined the Registered Nurse (RN) failed to provide specific and individualized written instructions regarding the patient's bathing requirements in 3 (#2, #7, and #14) of 10 (#1, #2, #3, #6, #7, #9, #10, #11, #13, and #14) current patients records reviewed with Hospice Aide (HA) services. This failed practice had the potential to affect all patients currently on census receiving aide services in that, the care provided may not be safe, efficient, and effective and had the potential for negative patient outcomes up to and including patient falls. Findings follow: --- Review of clinical record #2 with a SOC of 06/13/22 revealed a patient with a diagnosis of Malignant Neoplasm of Frontal Lobe of the Brain. Review of a document titled "Hospice Plan of Care Update 06/23/23" revealed the aide care plan included orders to assist the patient with a bath on each visit. No instructions for the type of bath documented. Review of clinical record #7 with a SOC of 06/05/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. Review of a document titled "Hospice Plan of Care Update 06/23/23" revealed the aide care plan included orders to assist the patient with a bath. No specific instructions for the type of bath or how frequently to assist with the bath documented. Review of clinical record #14 with a SOC of 12/10/22 revealed a patient with a diagnosis of Oropharyngeal Dysphagia. Review of a document titled "Hospice Plan of Care Update 12/10/22" revealed the aide care plan included orders to assist the patient with a bath on each visit. No instructions for the type of bath documented. An interview on 06/29/23 with Agency Personnel #2 confirmed the lack of specific and individualized written instructions documented on the aide care plan regarding bathing services.

Based on clinical record review and staff interview, it was determined the Registered Nurse (RN) failed to supervise and assess the quality of care and services through on-site supervisory aide visits (SAV) every 14 days in 1 (#6) of 10 (#1, #2, #3, #6, #7, #9, #10, #11, #13, and #14) current patients records reviewed with Hospice Aide (HA) services. This lack of supervision by the RN had the potential to place all patients receiving HA services at risk for adverse outcomes due to possible delays in the discovery of noncompliance with the Plan of Care by the HA or possible changes in the needs of the patient and family. Findings follow: --- Review of clinical record #6 with a SOC of 12/30/22 revealed a patient with a diagnosis of Peripheral Artery Disease. Review of a document titled "Hospice Plan of Care Update 06/09/23" revealed orders for HA services. Supervisory aide visits conducted on 05/01/23 and 05/18/23 (3 days past the 14-day time frame). An interview on 06/29/23 with Agency Personnel #2 confirmed the late supervisory aide visit.