Every finding on record at Carilion New River Valley Medical Center

Observed in Record Review. In 6 of 14 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#3 there was documentation that the patient was having difficulty swallowing that required a change in diet and addition of thickened liquids, yet the care plan did not reflect the changes. In review of RRNHV#5 the patient was diabetic and required adjustment of insulin dosage but no endocrine care plan to guide the care. In RRNHV#7 the documentation noted the patient to have a G-tube yet the care plan did not address the care of the G-tube site. In RRNHV#12 the patient had a terminal diagnosis of Protein Calorie Malnutrition with weight loss yet no nutrition care plan to guide the care. In RRNHV#13 the patient was utilizing BiPap yet the use of the BiPap was not reflected in the plan of care. In RRNHV#14 the documentation noted the patient with a UTI that required orders for antibiotics, and acetic acid flushes yet there was not a care plan opened to guide the care. These observations were reviewed with the Hospice Manager.

Observed in Record Review. In 5 of 14 patient records reviewed, the organization failed to ensure the plan of care included all drugs and treatment necessary to meet the needs of the patient. For example: on review of RRNHV#7 the medication profile included two medications Buspirone and Dicyclomine that were listed to be given by mouth yet the patient was NPO and had a G-tube for all meds and nutrition. In RRNHV#8 there was an order for Morphine that was confusing and contradictory as its instruction noted take 0.5 ml every 4 hours as needed by mouth for pain: Give 0.25 - 1 ml by mouth every 1 to 2 hrs as needed for pain. In RRHV#3 there was documentation of the addition of thickened liquids yet there was no physicians order to specify the desired consistency of the thickened liquids. In RRNHV#5 there was documentation that the patient's wife was performing blood glucose monitoring yet there were no orders for blood glucose monitoring noted on the record. In RRNHV#6 the documentation noted the patient had a colostomy yet there were no orders for the colostomy care noted on the record. These observations were reviewed with the Hospice Manager.

Observed in Record Review. In 1 of 14 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. For example: on review of RRHV#4 the plan of care included the order for the patient's biliary drain was for the skilled nurse to monitor drainage to collection bag and change dressing 1xwk utilizing aseptic technique. Over the last 3 weekly documented weekly nursing visits prior to survey, there was no documentation that the dressing was changed as indicated in the plan of care. On home observation of the RN for a weekly visit it was observed that the dressing was not changed. This observation was reviewed with the Hospice Manager.

Observed in Record Review. In 2 of 8 patient records reviewed, where hospice aide services were elected, the organization failed to ensure the RN provided complete written patient care instructions for the hospice aide. For example: on review of RRNHV#7 the patient had a G-tube yet the aide plan of care did not include instruction on how the aide was to handle the G-tube while providing care. In RRNHV#14 the patient had a Foley catheter yet there were no instructions on how to handle the Foley such as providing Foley care and/or emptying the collection bag. These observations were reviewed with the Hospice Manager.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization failed to ensure the patient record contain information that reflected the patient's care, treatment, and services. For example: on home observation for RRHV#1 in conversation with the patient caregiver the caregiver noted the patient was taking a medication for macular degeneration 2 times a day and also had been taking Vitamin D daily for quite some time, yet the medications were not included on Medication Profile as part of the plan of care. This observation was reviewed with the Hospice Manager.

Observed in Record Review. In 2 of 2 patient records reviewed, the organization failed to ensure the discharge summary included all required elements. For example: on review of RRDC#1, and RRDC#2 the discharge summary did not include a summary of the patient's stay, including treatments, symptoms, and pain management. These observations were reviewed with the Hospice Manager.