Every finding on record at Healthpartners Hospice and Palliative Care

Based on interview and document review the agency failed to ensure their emergency preparedness plan (EPP) addressed the use of volunteers in an emergency including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. This had the potential to affect all 265 patients who received services from the hospice agency. --- During review of the EPP, updated 8/2022, on 3/7/22, the policies and procedures did not include the use of volunteers in an emergency, or other emergency staffing strategies that utilized medical volunteers to address surge needs during an emergency. During interview on 3/7/22, at 2:00 p.m. hospice program manager stated the EPP did not contain a policy or procedure that addressed the training of and use of volunteers during an emergency or other emergency staffing strategies that included a process for integration of State and Federally designated health care professionals to address surge needs during an emergency.

Based on interview and document review, the agency failed to ensure their emergency preparedness plan (EPP) policies and procedures addressed the role of the facility under a waiver declared by the President and Health and Human Services (HHS) Secretary, in accordance with a declared 1135 waiver during a public health emergecy, (a waiver designed to waive specific regulatory requirements in order to more easily provide needed care in an emergency situation). This had the potential to affect all 265 patients who received services from the hospice agency. --- During review of the EPP, updated 8/2022, on 3/7/22, the policies and procedures did not include a procedure or policy to address the role of the agency under a declared 1135 waiver. During interview on 3/7/22, at 2:15 p.m. hospice program manager verified the agency EPP policies and procedures did not document facility operations or procedures under a 1135 waiver.

Based on observation, interview and document review, the hospice agency failed to develop a plan of care (POC) that included all prescribed medications for 1 of 6 patients (P17) whose medications were reviewed during home visit. --- P17's plan of care (POC) for the certification period 2/15/23 through 2/28/23, indicated an admission date 11/15/22. Diagnoses included progressive supranuclear palsy (an uncommon brain disorder) and fibromuscular dysplasia (abnormal development or growth of cells in the walls of arteries that can cause the vessels to narrow or bulge). The POC indicated skilled nurse visits (SNV) with one visit every 12 days, then two visits every 12 days, then one visit every week for ten weeks and one to three visits every 8 days for eight days. Various problems and goals were identified and included the skilled nurse to maintain safe medication status by assessing, monitoring medications for safety, effectiveness, interactions, duplicate therapy, compliance and side effects. The POC directed the skilled nurse to review medications and update the medication list with changes. P17's POC included the following medications: acetaminophen (fever reducer and pain reliever) 500 milligrams (mg) two tablets by mouth (po) two times per day (BID), atorvastatin (to treat high cholesteral) 40 mg one tablet po every day (qd), bisacodyl (to treat constipation) 10 mg suppository insert one suppository rectally daily as needed (prn), diclofenac 1% get (an anti-inflammatory gel) apply two grams (gm) to skin four times daily prn, finasteride (to treat enlarged prostate) 5 mg take one tablet po qd, lidocaine (local anesthetic) 4% patch apply one patch to skin qd, menthol-methyl salicylate (used to relieve minor pain) 35 g apply one application topically three times per day prn, metoprolol tartrate (to treat high blood pressure) 50 mg take one tablet po BID, Senna (a laxative) 8.6 mg take one tablet po BID prn. During a home visit on 3/2/23 at 10:00 a.m., family member (FM)-A showed surveyor a number of medication bottles that she set up daily for P17 to take. These bottles included: atorvastatin 40 mg, finasteride 5 mg, metoprolol 50 mg, acetaminophen 500 mg, Senna 8.6 mg, multi vitamins, and gabapentin (anti-convulsant and nerve pain) 100 mg. FM-A indicated she set up all the medications shown daily for P17 to take. The gabapentin was started a few weeks ago in early February and the dose had been adjusted until he was now taking two capsules of the gabapentin at bedtime to help him sleep. P17's medical record indicated a verbal order was received on 2/7/23, for gabapentin 200 mg po at bedtime, however, P17's POC and medication list failed to list the medication. When interviewed on 3/8/23, at 10:00 a.m. registered nurse (RN)-A verified gabapentin was not listed on P17's medication list or POC. RN-A stated, having a medication mistakenly omitted on the medication list and POC would be a problem. When a medication is not listed on the POC, it would not be visible to the hospice interdisciplinary group (IDG) and so could be potentially missed for review of side effects, interactions and efficacy of the medication. During interview on 3/8/23 at 12:45 p.m., the program manager (PM)-A indicated when new medications were ordered, they are approved and signed by the physician. The primary nurse would have to click the plus sign in the patient's medical record to have it added to the POC. They were then to print the new medication list and have it faxed. It would be important to have all medications the patient was taking on the POC for the IDG team to review. The agency's policy Care and Services with review date January 2023, indicated the pharmaceutical needs of patients would be met, consistent with all applicable laws, regulations, and accepted standards of practice. A patient-specific medication profile would be maintained and reviewed at least every 15 days to monitor for effectiveness, actual and potential medication-related effects, and untoward actions.

Based on interview and document review, the agency failed to ensure the physician orders were followed for 1 of 27 (P10) who had home health aide (HHA) services ordered, but the services had not been provided and the physician had not been notified the services were not provided. --- P10's plan of care (POC) for certification period 3/2/23 through 3/15/23, indicated a hospice admission date 1/25/23. Diagnoses included renal cell carcinoma (kidney cancer), malignant neoplasm to lung and both adrenal glands (cancer of lungs and adrenal glands). Skilled nurse visits (SNV) were ordered one to three times per week for twelve weeks and one to three visits as needed (prn) for various assessments and monitoring. A home health aide (HHA) was ordered one visit every week for ten weeks and then one visit every nine days for nine days to assist with bathing, dressing, hair and nail and skin care. P10's medical record indicated HHA services were ordered starting 1/30/23, however, lacked documentation of HHA visits performed. In addition, P10's medical record lacked documentation the physician had been notified of the agency's failure to provide the HHA services ordered. During interview on 3/8/22, at 10:45 a.m. registered nurse RN-A indicated P10 had been refusing the HHA visits and the service should not have been on P10's POC. When a patient refused services like the HHA services, the HHA should have been calling the patient each week and offering the visit and then documenting each of the refusals, or it needed to come off the care plan until the patient was willing to accept the service. The agency's practice was to either remove the service from the POC or the person responsible to provide the service would have to call the patient and reach out weekly or however often the range of service was ordered. When interviewed on 3/8/23, at 12:45 p.m. the program manager (PM) indicated the HHA should have reached out to the nurse case manager and notified the nurse case manager of the patient's refusal of visits. PM stated communication was a noted problem within the agency and was a current project they were working on. The HHA's did document their missed visits in the client's medical record when they occurred. If the service was on hold by the nurse, the medical record should have indicated that and the service needed to be removed from the patient's POC. The agency's undated policy Coordination and Continuity of Care, indicated the patient's medical record would contain documentation of care coordination as evidenced by team conferencing, telephone communication and visit records. The interdisciplinary group's (IDG) services would be adjusted according to the needs of the patient and/or family and would be coordinated and delivered by the individuals responsible for managing plan of care revisions.