Every finding on record at Harbor Hospice of Liberty LP

Observed in Record Review. In 5 of 10 patient records reviewed, surveyor observed in RRHV#2 and RRNHV#2 that patient had two as needed orders for mild pain and fever management, however, neither the order nor the policy specified which medication to use first. This was reviewed with the Administrator/Director of Nursing. Example #2, surveyor observed in RRHV#3 and RRNHV#1 that patient had two PRN medication orders for constipation management, however, neither the order nor the policy specified which medication to use first. This was reviewed with the Administrator/Director of Nursing. Example #3, surveyor observed in RRNHV#3 that patient had 3 PRN orders for pain management, however, neither the order nor the policy specified which medication to use first. This was reviewed with the Administrator/Director of Nursing.

Observed in Patient Home. In 1 of 3 individual tracers, the organization did not ensure effective education and training related to oxygen storage was completed. For example, during the home visit for RRHV#1 an oxygen tank was observed standing upright and unsecured in a storage closet. This observation was reviewed with the Administrator/Director Nursing.

Observed in Individual Tracer. It was noted that the patient's request for a copy of their DNR to display in their home did not occur for a month after the DNR form was signed by the physician. This patient also has a life - alert pendant which could trigger an ambulance to come to the home.

Observed in Individual Tracer. It was noted that the medication reconciliation was not updated in the nursing facility since the medications of Tessalon, Albuterol and Oral Acetominophen were not listed on the organization's medication profile in the organization's patient's record that is located in the facility for the organization to review.

Observed in Individual Tracer. The organization had not coordinated care of the patient, during a visit to the the patient in the nursing facility, the nurse did not review with the nursing facility staff or patient's facility records--- the patient's medications, the patient's end of life issues or the patient's weight to insure the care of the patient was consistent with the hospice and the facility . Also the patient's increase of 2 liters of oxygen to 10 liters of oxygen was noted on the patient's CTI but not shared with the Interdisciplinary Team Meetings.

Observed in Individual Tracer. It was noted the RN did not follow the manufacturer's guidelines when cleaning the equipment ( blood pressure cuff, thermometer, and stethoscope)-- the required wet- time of four minutes was not completed when cleaning the equipment used in patient - care. Also during the aide visit, it was noted that the aide had a clip board with several clipped papers in the clean area of her bag causing a risk since the paper can not be wiped to clean it and placed back in the clean side of the bag.

Observed in Record Review. It was noted that the hospice aide supervision was not performed at a 14 day interval with two different patients, as those supervision were completed at 15 days. Another supervision interval for the hospice aide exceeded 30 days.

Observed in HR File Review. There was no documented competencies completed or documented for the Hospice Medical Director .