Every finding on record at Kindred Hospice Inc

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to ensure the update of the comprehensive assessment was accomplished by the hospice interdisciplinary group as frequently as the condition of the patient requires but no less frequently than every 15 days. For example: on review of the record for RRHV#1 the last documented RN visit was early January leaving greater than 30 days since last comprehensive assessment update by the RN. This observation was reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 5 patient records reviewed, the organization failed to develop an individualized written plan of care with goals that were specific, measurable and time-bound. On review of RRHV#2 there were goals that were noted to not be specific, measurable and time-bound such as: Prevent discomfort due to increasing edema and Pt will have decreased anxiety related to respiratory changes. Pt will have optimum level of oxygen. In RRHV#3 an example was Patient Will minimize episodes of confusion and forgetfulness throughout benefit period These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 5 patient records reviewed, The organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on review of RRHV#3 the patient medication profile contained orders for multiple pain medications order for as needed use such as Acetaminophen, Ibuprofen, Hydrocodone, and Morphine yet there were no parameters or specific instructions to guide the user to know which medication to use for which type of pain. In RRNHV#5 the plan of care included an order for blood glucose monitoring 2 times a day yet the order did not specify who was to perform the monitoring as required. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 3 of 5 patient records reviewed, the organization failed to ensure the care and services were provided in accordance with the plan of care. For example: on review of RRHV#1 the hospice aide was ordered a frequency of 2 times a week yet in week 2 of January only one visit was documented, in week 3 of January no aide visits were documented, and no aide visits were documented since the end of week 4 January, 17 days prior to survey. Further, the skilled nurse (SN) was ordered weekly alternating RN with LVN visits. The last documented RN visit was early January leaving greater than 30 days since the last documented RN visit. In RRNHV#4 the SN was ordered weekly and there were no documented visits since late January 18 days prior to survey. In RRNHV#5 the SN was ordered weekly, there were 2 weeks in December without a documented SN visit. There was communication note that a visit had been declined that week, however there was no documentation that there was an attempt to reschedule the visit to meet the ordered frequency during the week. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 3 patient records reviewed, where aide services were utilized, the organization failed to ensure the Registered Nurse provide written patient care instructions for the hospice aide. For example: in RRHV#3 and RRNHV#4 the patient had a wound with dressings, yet there were no instructions on the aide plan of care to inform the aide on what to do with the dressings while providing care. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 1 of 3 patient records reviewed, where hospice aide services were utilized, the organization failed to ensure the aide provide services that are ordered by the physician in accordance with the aide plan of care. For example: on review of RRHV#3, In week 2 of February the aide was assigned to record BM and brush teeth, yet the tasks were not addressed on the documentation nor was there an explanation why the task was not performed. In week 3 or February peri care and visualize skin were assigned yet were not addressed in the documentation. These observations were reviewed with the Director of Nursing.

Observed in Record Review. In 2 of 3 patient records reviewed, where hospice aide services were elected, the organization failed to ensure the quality of care and services provided by the hospice aide were assessed no less frequently than every 14 days. On review of RRNHV#4 there were aide supervisory visits documented monthly from November to February and not every 14 days as required. On review of RRHV#1 there were no documented RN visits past early January therefore there were no aide supervisory visits documented for greater that 30 days. These observations were reviewed with the Director of Nursing.

Observed in HR File Review. The organization failed to ensure that physician services are made routinely available on a 24 hour basis 7 days a week. On review of the contract for the Medical Director the hours of availability were noted to be available from 8:00 - 4:30 Monday - Friday for on-call consultation, assistance and decisions regarding patient care. On discussion with leadership they noted that the Medical Director is available to them 24/7 yet the contract did not reflect the availability.

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to ensure the patient record contain information to reflect the patient's care, treatment, and services. For example: on review of RRHV#1 3 nursing notes by the LVN in January were noted to have a time in and time out but were otherwise blank. In discussion with Director of Nursing it was noted that the policy for submission of documentation was 7 days.

Observed in Record Review. In 1 of 5 patient records reviewed, the organization failed to ensure all entries in the record were appropriately authenticated in accordance with hospice policy and currently accepted standards of practice. For example: in review of RRHV#1 all clinical entries into the record were in a sign and submit status and therefore entries were not electronically signed by the clinician in the system. This observation was reviewed with the Director of Nursing.

Observed in Individual Tracer. The organization did not reduce the risk of infections associated with medical equipment, devices, and supplies. During home visit 1 it was noted that the nurse used ReadyKleen spray to disinfect equipment that was used to take vital signs. The guidelines on the ReadyKleen spray bottle stated that surfaces were to be wetted and allowed to dry for two minutes in order to be disinfected. The nurse sprayed the equipment, wiped the equipment with a paper towel and immediately placed the equipment into the nursing bag without dry time. This was confirmed by the Director of Patient Care Services.