Every finding on record at Intermountain Front Range, Inc.

Observed in Individual Tracer. In 9 of 9 individual tracer records reviewed, it was noted that the organization did not ensure that the Hospice Agreement and Election of Benefits Form(s) were completed as required. For example, a review of the Hospice Agreement and Election of Benefits Form for IPU#1, IPU#2, IPU#3, RRHV#1, RRHV#2, and RRHV#3, RRHV#4, RRHV#5, and RRHV#6, revealed that patients were not informed of their financial responsibility prior to beginning care, treatment, or services. During a review of the Hospice Agreement and Election of Benefits Form the following information was noted: (6) Financial Coverage of Hospice Care: As a Medicare certified hospice, LH may receive funding for hospice care through Medicare/Medicaid/private insurance companies. I, or my responsible party, understand that: I am responsible for insurance company deductibles, co-payments and non-covered services; I am financially responsible for charges if I lose my funding source. However, this document did not indicate the dollar amount of financial responsibility and was signed by the patient or the patient's caregiver. This observation was reviewed with the Senior Executive Director Post Acute Services.

Observed in Record Review. In 1 of 23 patient records reviewed it was noted that the organization did not ensure the patient's right to choose an attending provider was implemented. For example, during a review of the consent in the medical record for RRHV#2, the Line titled Provider Full Name did not include the provider's complete name. This observation was reviewed with the Senior Executive Director of Post Acute Services.

Observed in Record Review. In 1 of 3 discharged records reviewed, it was noted that the patient's right to revoke hospice services was not fully implemented. For example, a review of the medical record for RRDC#2 revealed that the revocation statement did not include the patient's admission date and the benefit election period. This observation was reviewed with the Senior Executive Director Post Acute Services.

Observed in Record Review. In 6 of 23 patient records reviewed, it was noted that the organization did not ensure that the plan of care goals included outcome measures for specific care activities. For example, during a review of the medical record for IPU#1, and IPU#2, the following goal statement was noted, “Optimal Respiratory Comfort”. The goal statement did not include a method to measure the effectiveness of problem interventions. Example #2: During a review of the medical record for RRHV#1,RRHV#2, RRHV#3, and RRHV#4 the following goal statement was noted, “Patient's pain/physical discomfort will be reduced to the level of patient's stated goal.” The goal statement or interventions did not include the patient's stated goal. This observation was reviewed with the Senior Executive Director Post Acute Services.

Observed in Record Review. In 1 of 6 individual tracers, it was noted that the organization did not ensure the plan of care included all required information. For example, during a review of the medical record for RRHV#2, the plan of care included the following order for oxygen therapy: Oxygen at 2 liters per minute. The order did not specify the device for oxygen delivery. This observation was reviewed with the Senior Executive Director Post Acute Services. Observed in Record Review. In 2 of 23 patient records reviewed, it was noted that the organization did not ensure the plan of care was revised when the patient’s condition changed. For example, during a review of the medical record for RRHV#4, it was noted that a clinician documented 3 falls with skin tear injuries. During week 2 of the 3rd benefit period the clinician documented fall with no injury. The plan of care was not updated with interventions to maintain patient safety, strategies to prevent injury, and a goal statement to evaluate response to care, treatment and services related to fall prevention interventions. Example #2: A review of the medical record for RRNHV#12, revealed that the plan of care was not updated when the patient's condition changed related to pain management. The plan of care was not updated with interventions to manage symptoms related to pain, and a goal statement to evaluate response to care, treatment and services related to pain management. This observation was reviewed with the Senior Executive Director Post Acute Services.

Observed in Individual Tracer. In 1 of 6 individual tracers, it was noted that the organization did not ensure patient care, treatment, or services were provided according to the patient's individualized plan of care. For example, a review of the medical record for RRHV#2, revealed the plan of care included the following order for oxygen therapy: Oxygen at 2 liters per minute. During tracer activities, it was noted that the oxygen concentrator was set at a rate of 0.5 liters per minute. This observation was reviewed with the Senior Executive Director Post Acute Services.

Observed in Individual Tracer. Example #2: During individual tracer activities for RRHV#2, it was noted that the clinician used a Sani-Cloth to clean equipment. The clinician wiped each piece of equipment with the Sani-Cloth and immediately returned each piece of equipment to her nursing bag. The Manufacturer recommendations for use stated: Unfold a clean wipe and thoroughly wet surface. Allow treated surface to remain wet for three (3) minutes. Let air dry. The manufacturer recommendations for use were not implemented. This observation was reviewed with the Senior Executive Director Post Acute Services. . Observed in Individual Tracer. In 2 of 6 individual tracers, it was noted that the organization did not ensure manufacturer's recommendations for cleaning medical equipment was implemented. For example, during individual tracer activities for RRHV#1, it was noted that the clinician used a Sani-Cloth to clean equipment. The clinician wiped each piece of equipment with the Sani-Cloth and immediately returned each piece of equipment to her vital sign equipment case. The Manufacturer recommendations for use stated: Unfold a clean wipe and thoroughly wet surface. Allow treated surface to remain wet for three (3) minutes. Let air dry. The manufacturer recommendations for use were not implemented. This observation was reviewed with the Senior Executive Director Post Acute Services.