Every finding on record at Kaiser Foundation Hospitals

Observed in Record Review. In 1 of 20 patient records reviewed, During HOSRR# 2's patient record review it was noted the organization had not ensured the comprehensive assessment was completed no later than five calendar days after the election of hospice. For example: review of the Chaplain's initial comprehensive assessment revealed the visit was six days after the election of hospice. Review of HOSRR# 2's patient record revealed Chaplain documentation Delay in Work Order with no other documentation to indicate why the Chaplain delayed the comprehensive assessment. This was reviewed, discussed, and validated with the Director of Patient Care Services.

Observed in Patient Home. In 1 of 3 home visits conducted with medication reconciliation, During HOSRRHV# 2's home observation it was noted the organization had not ensured the registered nurse (RN) assessed potential medication related problems to include ineffective drug therapy. For example: During HOSRRHV# 2's home observation the RN was observed completing medication reconciliation. During medication reconciliation it was noted the Hydrocodone/Acetaminophen 5-325mg medication had expired approximately 30 days prior to the home observation and approximately 20 days prior to the election of benefit/start of care. In addition, HOSRRHV# 2 had been taking Culturelle daily for approximately six months prior to the home observation per HOSRRHV# 2's husband. Review of the medication profile revealed no documentation of Culturelle. This was reviewed, discussed, and validated with the Hospice Clinical Supervisor during the home observation.

Observed in Record Review. In 1 of 20 patient records reviewed, During HOSRRHV# 2's record review it was noted the organization had not ensured it maintained complete and accurate patient records. For example: review of HOSRRHV# 2's start of care registered nurse comprehensive assessment revealed documentation that a discussion regarding advanced directives had taken place and the POLST was completed with a DNR [Do Not Resuscitate] status. Review of HOSRRHV# 2's plan of care revealed HOSRRHV# 2 had a DNR. During HOSRRHV# 2's home observation it was noted the POLST was blank in the home folder. HOSRRHV# 2's Son shared they had not decided on how to complete the POLST and needed more time before completing it. Review of the Medical Social Worker's initial assessment revealed the POLST was discussed and the family wanted more time before completing the POLST. This was reviewed, discussed, and validated with the Director of Patient Care Services.

Observed in Record Review. In 7 of 20 patient records reviewed, During HOSRRHV# 1, HOSRRHV# 2, HOSRRHV# 3, HOSRRHV# 4, HOSRRHV# 5, HOSRR# 6, and HOSRR# 7's patient records review it was noted the organization had not ensured the registered nurse provided complete written patient care instructions for the hospice aide. For example: review of HOSRRHV# 1's plan of care revealed HOSRRHV# 1 had continuous oxygen at 4 lpm via nasal cannula. Review of the hospice aide written patient instructions revealed the task of a shower and documentation under Safety that included oxygen. However, further review of the patient written instructions revealed no oxygen precautions or directions regarding whether or not the oxygen could or should be removed during the shower. Review of HOSRRHV# 2, HOSRRHV# 3, HOSRRHV# 4, HOSRRHV# 5's patient records revealed the patients were fall risks. However, review of the hospice aide written patient instructions revealed no documentation of fall precautions. Review of HOSRR# 6 and HOSRR# 7's patient record revealed both patients had oxygen 2 lpm as needed. However, review of HOSRR# 6 AND HOSRR# 7'S hospice aide written patient instructions revealed no documentation regarding oxygen or oxygen precautions. This was reviewed, discussed, and validated with the Director of Patient Care Services.