Every finding on record at Cp Seattle Wa Hospice, LLC

Based on record review and interview, the agency failed to ensure that agency staff followed the physicians orders written in the Plan of Care (POC) for the Pro Re Nata (PRN), as needed, nursing visits for 3 of the 20 active patients (Patient #104, Patient #105, and Patient #110). Failure to follow the physicians orders in the patients POC may potentially have a clinical impact on the patients hospice care. --- Findings included: 1. Document review of the agencys policy titled, ";Plan of Care", (Date Revision: 07/2023) showed that the plan of care is based on physicians orders that reflect the patients and familys needs. 2. Record review of patient records (Patient #104, Patient #105, and Patient #110) showed: a. Patient #104s election date was on 05/24/24 with a primary diagnosis of Sepsis. Skilled nursing services were ordered with frequencies of 1 visit every week for 9 weeks, and 6 PRN nursing visits for pain and symptoms management. Review of the patient's record described the following PRN Nursing visits: i. On 05/26/24, a PRN nursing visit was made to drop off items. ii. On 05/31/24, a PRN nursing visit was made to check on the patient's right toe. iii. On 06/20/24, a PRN nursing visit was made for a post fall. iv. On 06/23/24, a PRN nursing visit was made to drop off items. There was no other documentation to show that the PRN nursing visits were made for pain and symptoms management as ordered by the physician. b. Patient #105s election date was 07/31/24 with a primary diagnosis of Pancreatic Cancer. Skilled nursing services were ordered with frequencies of 1 visit every week for 13 weeks, and 6 PRN nursing visits for symptoms management. On 08/09/24, a PRN nursing visit was made for a case conference visit. There was no other documentation to show that the PRN nursing visit was made for symptom management as ordered by the physician. c. Patient #110s election date was 01/02/24 with a primary diagnosis Severe Late-Onset Alzheimers Dementia. Skilled nursing services were ordered with frequencies of 1 visit every week for 9 weeks, and 4 PRN nursing visits for symptom management. Review of the patient's record described the following PRN Nursing visits: i. On 01/21/24, a PRN nursing visit was made as a routine visit. ii. On 01/28/24, a PRN nursing visit was made as a routine visit. iii. On 02/01/24, a PRN nursing visit was made as a routine visit. There was no other documentation to show that the PRN nursing visits were made for pain and symptom management as ordered by the physician. 3. On 08/15/24 at 8:15 AM, Surveyor #1 interviewed the agencys Hospice Director (Staff 115) regarding their use of PRN nursing visits. Staff #115 acknowledged the findings and stated that the agency has no policy on PRN nursing visits. In addition, Staff #115 was unable to provide documentation to show that the PRN nursing visits were made as ordered by the patients physician.