Every finding on record at Heritage Hospice, Inc

Based on clinical record review, staff and family interviews, it was determined the hospice failed to ensure that care and services provided are based on all assessments of the patient and family needs by failing to deactivate an implantable cardioverter defibrillator (ICD) for one patient (P) (P#1) of four sampled patients. --- Findings Include: Clinical record review for P#1 revealed admission to the inpatient hospice unit (IPU) on 4/9/2024 at 7:00 p.m. P#1 expired at the in-patient unit on 4/10/2024 at 6:04 p.m. Review of the History and Physical (H&P) from the hospital identifies an implanted defibrillator inserted in the left chest. Review of the document titled ";Initial Nursing Assessment" by RN DD, dated 4/9/2024 reveals P#1 had a pacemaker with ";DIFF". Review of the document titled ";Nursing Visit Record" by RN CC, dated 4/10/2024, revealed P#1 ";has a pacemaker but has been tachycardic and having an uneven pulse today." Further review revealed an addendum to the visit record was added by RN CC on 6/5/2024 which revealed P#1s family member notified RN CC that P#1 was having ";muscle twitching" after the pronouncement of death. RN CC documentation revealed the RN placed the Medtronic magnet over P#1 heart and the twitching resolved. On 6/3/2024 at approximately 12:00 p.m., an interview with the Director of Clinical Operations (DCO) revealed the agency does not have a policy for deactivating implantable cardioverter defibrillators (ICDs). However, on 6/4/2024, a policy titled, ";Deactivating the ICDs (Implantable Cardioverter Defibrillators) of Hospice Patients" dated 6/24 was presented as a new policy. On 6/3/2024 at approximately 5:00 p.m., a telephone interview with the family member of P#1 revealed that the family was told at recently visited hospital that the Implantable Cardioverter Defibrillator (ICD) would be turned off upon arrival at the in-patient unit (IPU). The family asked nurses on both 4/9/2024 and 4/10/2024 if the defibrillator had been turned off. The family was told the nurses would have to check with the doctor, but family never heard if the doctor was notified of the request. The family member counted nine times that P#1 ";jolted"- the family was holding P#1s hand and it ";clenched". After three times, the family went to get the nurse and asked about the ICD and was told, ";I didnt even know she had one". A magnet was applied, and the movements stopped. No one ever asked for the Medtronic's card (card from the ICD company with contact information). On 6/4/2024 at approximately 2:20 p.m., a telephone interview with RN CC confirmed she observed P#1 experiencing ";muscle twitching" as reported by P#1s family and stated she was aware P#1 had an ICD but did not relate twitching with the ICD until the family questioned if it could be the defibrillator. She stated she then applied a magnet to the chest of P#1 and that the twitching resolved. She confirmed she did not get a physicians order for the magnet. RN CC further revealed she had not received any training on deactivating ICDs with a magnet.