Every finding on record at Fairbanks Memorial Hospital

Observed in Patient Home. In 2 of 3 home visits conducted, where medication reconciliation was completed, the organization failed to assess and reassess its patient's. During home visits for HOSRRHV#1 and HOSRRHV#2, the Hospice Nurse Surveyor observed the nurses failed to identify all medications during their medication assessment. The surveyor asked both nurse to perform a medication reconciliation based on policy and neither nurse reviewed the entire list and compared the bottles to what was on the list. In HOSRRHV#1, the nurse had to be prompted to look at the comfort kit and still did not review the bottles. She picked up the baggy and waived it at the surveyor. She also did not request all medications stating she doesn't take those others regularly. In HOSRRHV#2, the nurse did not compare bottles of medications to the list she had. She stated the assisted living manage them and tell me what is needed. The patient had some medications in his own apartment that family and private caregivers were providing. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 16 patient records reviewed, the organization failed to assess and reassess its patient's. During record review for HOSRRHV#4, the Hospice Nurse Surveyor observed the initial bereavement assessment was not completed. This was verified with the Hospice Manager. The Spiritual Care provider was refused and the SW did not document a bereavement assessment. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to maintain a complete and accurate record. During record review for HOSRRHV#2, the record contained conflicting information. For example in HOSRRHV#2, the CTI 13 days prior to survey and the SOC nursing note 21 days prior to survey stated the patient was on hospice services for heart failure. But the SW and RN had been documenting in their narratives and IDG notes that the patient was on for protein calorie malnutrition. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to provide care, treatment, or services as required. During record review for HOSRRNHV#5, the Hospice Nurse Surveyor observed the orders were not completed. For example in HOSRRNHV#5, the patient had orders for wound care that read Decubitus/Pressure Ulcer Stage II / Left Buttocks Stage 2 pressure ulcer to left buttocks. Apply barrier cream with every brief change and apply Allevyn over. May keep Allevyn in place up to 7 days if clean, dry and intact, change as needed if soiled. Make sure to check for wet brief every 2 hours and change it, including overnight. Patient is unable to report when she has a soiled brief. There were no orders for cleansing prior to applying the dressing. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to provide care, treatment, or services for each patient. During record review for HOSRRHV#3, the Hospice Nurse Surveyor observed the orders were not all being followed. For example in HOSRRHV#3, the patient had orders to flush the port a cath once a month. The nurse documented that the patient did not want the port flushed any longer and the nurse documented RN agrees. There was not an order to discontinue the flushes and no collaboration with the MD. Also with HOSRRHV#3, the patient had orders for 4.5 liters oxygen continuous. The nurse had several narratives documenting patient is on 2-3 liters oxygen. There was also narrative stating patient adjusts oxygen as she finds appropriate. This was discussed and reviewed with the Hospice Leadership Team. Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to provide care, treatment, or services for each patient. During record review for HOSRRNHV#1, the patient had orders for aide visits 2x week. There were no aide visits for the week before survey. This was confirmed with the Hospice Manager. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 19 patient records reviewed, the organization failed to provide interdisciplinary, collaborative care, treatment, or services. During the home visit and record review for HOSRRHV#1, the Hospice Nurse Surveyor observed and reviewed that the nurse had a conversation with the primary care giver 8 days prior to survey related to stopping the Senna due to diarrhea. There was no documentation that the nurse contacted the provider to collaborate and review this information. IDT had taken place in between and there was no documentation of conversation about the diarrhea and stopping of senna. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Patient Home. In 1 of 4 home visits conducted, the organization failed to respect, protect, and promote patient's rights. During the home visit for HOSRRHV#1, the Hospice Nurse Surveyor observed the RN was changing a wound bandage for the patient who was lying on the hospital bed in the Livingroom. Multiple male individuals entered the home to speak with patient's grand-daughter. The RN did not cover the patient or intercept in any way. This was verified with the RN senior manager who was at the visit with the surveyor. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 2 of 19 patient records reviewed, the organization failed to maintain a patient record that contained information that reflected the patient's current care, treatment, or services. During record review and home visit for HOSRRHV#1 and HOSRRHV#2, the Hospice Nurse Surveyor observed the medication list in the EMR and in the home was inaccurate. For example in HOSRRHV#1, the Senna had been stopped but was still on the medication list and the patient was no longer suing her Refresh eye drops. In HOSRRHV#2, the patient had Tylenol at the bedside which the daughter was giving him but it was not on the medication list. The patient did have Percocet on the medication list which he was also continuing to use. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In one of two records requiring discharge summary, the Associate Director of Nursing confirmed that the discharge summary was not provided to the accepting community physician after discharge.

Observed in Emergency Management Session. During the Emergency Management system tracer, the hospice surveyor learned that emergency preparedness training was not provided to a Certified Nursing Assistant, and a Volunteer during orientation and/or every year as required by policy. These observations were validated during the HR competence session. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Record Review. In 7 of 13 patient records reviewed, it was noted that initial comprehensive assessments were not completed by all disciplines within five days of the election of the hospice benefit. In the record of HO HV#1, HO RR#1, HO RR#2, HO RR#3, HO RR#4, HO RR#5, HO RR#6, the Spiritual Counselor did not document completion of this requirement within the allotted time frame. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Record Review. In 5 of 13 patient records reviewed, the hospice did not assess its patients and families. During review of patient records HO HV#1, HO HV#2, HO RR#2, HO RR#6, and HO RR#8, it was learned that that initial bereavement assessments were not completed as part of the initial comprehensive assessment at admission. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Record Review. In 8 of 13 patient records reviewed, where spiritual care support was ordered in the plan of care, the surveyor learned that the service was not provided according to the scheduled frequencies. This was noted in the records of HO HV#1, HO RR#1, HO RR#2, HO RR#3, HO RR#4, HO RR#5, HO RR#6, and HO RR#8. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Data Session. During the data session it was learned that leaders were unable to speak to how the organization analyzed and compared internal data over time to identify levels of performance, patterns, trends, and variations. This was confirmed by the Director of Home and Palliative Care services and the Hospice Manager. Observed in Data Session. During the data session it was learned that leaders did not analyze data over time to identify opportunities for improvement in quality measures. This was confirmed by the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Patient Home. During HO HV#1 the surveyor observed that at the patient’s request a C.N.A removed a soiled Mediplex dressing and applied a new one over a bony prominence on the back. However, removing and replacing dressings was not part of the plan of care and the aide did not call an RN for permission to do this. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.

Observed in Record Review. In 13 of 13 patient records reviewed, the hospice did not ensure that education and training to the patient included procedures to follow if care, treatment, or services were disrupted by a natural disaster or emergency. In the patient’s handbook at HO HV#1 and HO HV#2 the surveyor found that patients were not given a copy of or educated on an individualized emergency plan that considered the patient's specific needs such as use of oxygen, mobility issues, etc. This was reviewed with the Director of Home and Palliative Care services and the Hospice Manager.