Every finding on record at Harbor Hospice of Mcallen, LP

Observed in Patient Home. In 1 of 2 home visits conducted, with staff nurses, it was noted that the hospice nurse failed to conduct a medication assessment. For example, during RRHV#2 the LVN asked if there had been any changes to the medications, but did not assess for potential medication related problems such as adverse effects, drug reactions, significant side effects, and significant drug interactions, including ineffective drug therapy, duplicate drug therapy, and noncompliance with drug therapy. During discussion the patient stated during that she had been using Trazadone 150 for sleep for a long time and it was not included on the POC or medication list. The organization's Medication Management policy stated that during hospice visits, the medication profile will be used as a teaching guide to ensure that the patient and family/caregiver, as well as other clinicians, understand the medication regimen. This was confirmed with the RN Administrator present.

Observed in Record Review. In 1 of 2 patient records reviewed, for discharged patients, it was noted that the assessment was not updated. For example, in record RRDC#1 the patient was discharged for extended prognosis however the assessments and IDG documentation did not reflect a lack of declining condition. The RN documented continues with sudden decline in health in the assessment and the IDG documentation did not include discussion of patient discharge for extended prognosis. This was discussed with the Administrator and Regional Director present.

Observed in Record Review. In 9 of 14 patient records reviewed, of active patients, it was noted that the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. For example in record RRHV#1 all the documented goals time frames were 5 months in the past and the assessment included high risk for falls and there was no related goal. In records RRHV#2 5 goals time frames were 1 and 3 months in the past, RRHV#3 7 goals time frames were 6 and 5 months in the past, and RRHV#4 2 goals time frames were 3 months in the past. RRNHV#2 1 goal time frame was 2 months in the past, RRNHV#3 7 goals were 1 and 3 months in the past, RRNHV#8 and #9 both 4 goals were 1 month in the past, and RRNHV#4 6 goals time frames were 5 months in the past. This was discussed with the Administrator and Regional Director present.

Observed in Record Review. In 1 of 4 home visits conducted, it was noted that the plan of care did not include medications and treatment necessary to meet the patient’s needs. For example in RRHV#3 it was noted that Zinc Oxide Ointment was being used for wound care, however it was not included on the POC. This was observed with and discussed with the Administrator present.

Observed in Record Review. In 7 of 11 patient records reviewed, that included aide services, it was noted that the hospice aide supervision was not done every 14 days. For example in record RRHV#1 the RN had not documented any aide supervision for greater than 7 months. In records RRHV#4, RRNHV#2 and RRNHV#10 one time the supervision was completed in 15 days. In record RRHV#2 the supervision was completed twice in 16 days and once in 17 days. In record RRNHV#3 the order stated and the aides documented 2 HHAs required for care at each visit, however each supervision was completed for only 1 aide. In RRNHV#8 HHA services were provided for 2 months with no documented supervision . This was confirmed with the DON present.

Observed in HR File Review. In 1 of 1 HR files reviewed, it was noted that staff competency was not initially assessed and documented as part of orientation. For example, in the volunteer's HR file there was a copy of the volunteer competency form with the volunteer's name on it and the signature completed, however the document was blank with no areas filled out. This was confirmed with the Volunteer Coordinator who stated that she was not sure who was supposed to fill out the document.

Observed in Patient Home. In 2 of 3 home visits conducted, that included oxygen therapy, it was noted that education and training was not provided during the visit. For example during RRHV#2 the patient had multiple questions related to the oxygen equipment that she had been using in her home for many weeks such as what water to use and how to put it in the container and the amount to turn the dial to. The patient could not verbalize the 2 liter oxygen ordered. The LVN repeatedly stated she would go back the next day to take care of the oxygen, not educating the patient until the leadership stepped in at the end of the visit to ensure the patient had the knowledge needed that day. The patient was using oxygen daily. There was education documented at admission. During RRHV#3 the patient was on 100% oxygen and had many back up tanks in the home, however it was noted that 3 tanks were freestanding. This was confirmed with the RN Administrator present.