Every finding on record at Mission Hospice & Home Care

Observed in Record Review. In 1 of 18 patient records reviewed, the organization failed to ensure the comprehensive assessment was completed no later than five calendar days after the election of hospice care. In RRNHV#10 the psychosocial assessment and initial bereavement risk assessment was not documented until March, a month after the election of benefits. These observations were reviewed with the DPCS, Quality Director, and Director of Hospice.

Observed in Record Review. In 2 of 18 patient records reviewed, the organization failed to ensure a patient-specific comprehensive assessment and reassessment that identified the patient’s need for hospice care and services was conducted. In review of RRNHV#12 the patient was diabetic with an injectable and 2 oral hypoglycemics yet there was no documentation that an assessment of the endocrine system had been conducted such as history of blood glucose monitoring, patient's symptom of hypo and/or hyperglycemia. In RRNHV#17 the documentation noted the presence of a peg tube on admission, yet there was no documentation of an assessment of the peg tube site on admission. These observations were reviewed with the Quality Director, Education Coordinator, and Director of Hospice.

Observed in Record Review. In 4 of 18 patient records reviewed, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. On review of RRHV#1 the patient was noted in the home to be very unsteady requiring assistance with transfers and ambulation and the documentation noted a high fall risk yet there was no care plan established to address the fall risk and mobility issues. In RRHV#4 the patient was diabetic with the use of oral hypoglycemics and documentation in the CTI of weight loss yet the there was no care plan to address diabetes and signs and symptoms of hyper and/or hypoglycemia. The patient had documentation of agitation with combative behaviors yet no nursing care plan to address the issue. In RRNHV#7 there was an established goal that read patient will demonstrate adequate symptom relief from dyspnea as evidenced by WDL respiratory rate and breathing effort, however there was no order or intervention to define the limits. In RRNHV#12 the patient was diabetic on an injectable and 2 oral diabetes medications yet there was no care plan established to monitor and guide the care. These observations were reviewed with the DPCS, Quality director, and Clinical Team Manager.

Observed in Record Review. In 3 of 18 patient records reviewed, the organization failed to ensure the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. On review of RRHV#5 the documentation noted the patient with difficulty swallowing. On home observation the caregiver noted they were using thickener to nectar consistency in the patient's liquids yet there was no physicians order noted on the plan of care for thickened liquids. In RRNHV#14 there was documentation of a wound and the LVN provided wound treatment, yet there was no order for the wound care until nearly two weeks later. In RRNHV#17 the patient had a peg tube on admission yet the presence of the tube nor the site care was reflected on the plan of care from admission until the tube was removed in April and a care plan for care to the site after removal was addressed. These observations were reviewed with the Education Coordinator, DPCS, and Quality Director.

Observed in Record Review. In 2 of 18 patient records reviewed, the organization failed to ensure the registered nurse prepared written instructions for the hospice aide. On review of RRHV#4 the documentation and conversation with the RN and caregiver in the home noted the patient with agitation and combative behaviors during assessment and bathing, yet there was no instruction on the hospice aide plan of care to make the aide aware of the issues with agitation nor instructions on how to handle the behaviors while providing care. In RRNHV#8 the patient had a foley catheter yet the catheter was not reflected on the aide plan of care. These observations were reviewed with the Quality Director.

Observed in Record Review. In 1 of 18 patient records reviewed, the organization failed to ensure the hospice aide provided services that were ordered in the plan of care. In review of RRNHV#8 the aide documentation did not specify that tasks assigned were completed in the visit. In a visit in April and one in May the aide checked that bed bath was completed but all other tasks were left blank with no explanation as to why the tasks were not completed. This observation was reviewed with the Guality Director, Director of Hospice, and Education Coordinator.

Observed in Patient Home. In 1 of 6 home visits conducted, the organization failed to ensure that the patient record contain all information to reflect the patient's care, treatment, and services. On review of RRHV#2 during medication reconciliation the Tylenol bottle in the patient home was labeled Q 4 hours PRN, yet the current medication order per the plan of care was Q6 hours PRN. The medication profile instruction for oxygen and Morphine both listed instructions of use first line for shortness of breath. On discussion with the RN the Morphine should have read use 2nd line and only the oxygen use 1st line. These observations were reviewed with the RN, and the Clinical Team Manager.

Observed in Tracer Activities. Upon review of live discharge records, the Chief Administrative Officer and Quality Nurse confirmed that the hospice did not provide the patient's discharge summary to the receiving hospice.

Observed in Record Review. In 3 of 16 patient records reviewed, It was found in 3 of 16 records reviewed that the Plan of Care Goals were not realistic. Goals for pain and respiratory and safety issues had stated goals to be achieved by the end of the benefit period. This was verified with the Clinical Manager.

Observed in Individual Tracer. It was observed on HV#4 that the nurse cleaned her pulse ox with a Sani Wipe and immediately placed it back in the travel pouch. The manufactures instructions state the equipment to be cleaned was to remain wet for 2 minutes. The nurse did not keep the equipment wet for 2 minutes. In review of the organization policy it states the equipment should be cleaned with alcohol. This was verified with the Compliance Officer.

Observed in Individual Tracer. In 2 of 4 home visits conducted, It was found on HV#2 and HV#4 that care givers needed further education on the storage of oxygen. E tanks were found in the closets on HV#1 and HV#4 and the caregivers were not aware that they should not store the tanks in a closet. This was verified with the Compliance Officier