Every finding on record at Devoted Hospice, Inc

Upon patient record review, 3 of 14 (Patient #3,4,10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #3, 10: There is evidence on the medication record Oxygen 2-5 L/min via nc as needed. There is no oxygen saturation titration scale. Patient #4: There is evidence on the medication record Nitro 0.4 mg one tablet SL every 5 minutes to a maximum of 3 doses. There is no instruction as to what to do after 5 minutes and taking total of max doses.

Observed in Emergency Management Session. In review of the organization's written Emergency Operations Plan, the surveyor found that it did not describe the recovery strategies, actions, and individual responsibilities necessary to restore the organization’s care, treatment, or services after an emergency. This was discussed with the Administrator/DPCS and the office manager.

Observed in Record Review. In 5 of 5 patient records reviewed, the surveyor found that the organization had not consistently identified measurable goals based on problems identified in the initial, comprehensive, and ongoing assessments. Examples of outcomes that were not measurable for HV1 included the following: Patient will have no complications to physical health related to impaired mobility. Examples of outcomes that were not measurable for HV2 included the following: Optimal Bowel elimination and comfort for the next 6 months -Pt/family/PCG will verbalize having elimination needs met at an acceptable level: every 1-2 day, -Pt/Family/PCG will verbalize having urinary elimination needs met at an acceptable level. Examples of outcomes that were not measurable for HV3 included the following: Be able to cope with changes and express better coping skills in the next 90 days -Bereaved will have knowledge of how to utilize bereavement services. -Optimal coping and acceptance of death by Family/PCG -Patient will take medication as ordered. In addition, the following goal was noted: Patient/family will not report any side effects from the medication. However, there was intervention to teach this information. Examples of outcomes that were not measurable for RR1 included the following: Facilitate an optimal spiritual environment to begin the bereavement process and assure spiritual support is available at all times, -Facilitate natural and peaceful death. Examples of outcomes that were not measurable for RR2 included the following: 1< episode of constipation in the next 14 days, -Optimal bowel elimination and comfort, -Facilitate optimum bowel movement, -Facilitate natural and peaceful death with pain level <2. This was discussed with the Administrator/DPCS and the office manager.

Observed in Record Review. In 1 of 5 patient records reviewed, the surveyor noted that the plan of care did not include interventions to manage symptoms related to use of an anticoagulent. For example, in review of the medical record for HV1, the plan of care did not address the education (use, bleeding precautions, signs of complications, etc) required for safe use of Plavix. This was discussed with the Administrator/DPCS and the office manager.

Observed in Record Review. In 1 of 5 patient records reviewed, the surveyor noted that the organization had not specified the unique medications and treatments necessary to meet the patient's needs. For example, in review of the medical record for HV3, the surveyor found that the plan of care had Ibuprofen and Tylenol ordered as needed for pain without further defining when each one should be taken. This was discussed with the Administrator/DPCS and the office manager.

Observed in Individual Tracer. In 3 of 3 home visits conducted, the surveyor observed that the staff member did not follow organization infection control policy 9-014, Bag Technique. During the home visit for HV1, HV2, and HV3, the surveyor observed the same staff member provide care during the three visits. The staff member cleaned her reusable medical equipment with a sani-cloth. Organization policy required the use of alcohol and/or soap and water, which ever would be appropriate. This was discussed with the Administrator/DPCS and office manager. Observed in Individual Tracer. In 3 of 3 home visits conducted, the surveyor observed that the staff member did not follow organization infection control policy 9-014, Bag Technique. During the home visit for HV1, HV2, and HV3, the surveyor observed the same staff member provide care during the three visits. The staff member cleaned her reusable medical equipment and then placed it immediately into her equipment bag. She did not perform hand hygiene prior to returning the equipment to the bag as required by organization policy. This was discussed with the Administrator/DPCS and office manager.

Observed in Record Review. In 2 of 5 patient records reviewed, the surveyor noted that the organization had not provided all required instruction on the safe use of home oxygen. For example, in RR1 and RR2, the home oxygen safety risk assessment identified there was a fire safety risk in the home but the risk was not further identified and there was no instruction on any specific recommendations to address the risk. In addition there was no instruction on the causes of fire or the risks to neighboring residences and buildings. This was discussed with the Administrator/DPCS and the office manager.