Every finding on record at Parkview Hospital, Inc.

Observed in Record Review. In 2 of 21 patient records reviewed, the organization had not informed the patient of the patient's rights prior to beginning care, treatment, or services or during the initial evaluation visit before beginning care, treatment, or services verbally or in writing. In the charts for RRNHV#9 and RRD/C#1, there was no information provided in the patient rights or consent document that described the patient's financial responsibilities for payment. This was discussed with the Supervisor assisting with record review.

Observed in Record Review. In 2 of 21 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RRHV#1 the patient had music therapy and massage therapy ordered. The plan of care included the frequency of visits, however no goals for these disciplines. In the chart for RRHV#3, the patient had massage therapy ordered and the frequency of visit was on the plan of care, however no goals. This was discussed with the Supervisor assisting with record review.

Observed in Record Review. In 6 of 21 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: treatment necessary to meet the patient’s needs. In the chart for RRHV#1 the patient had music therapy and massage therapy ordered. The plan of care included the frequency of visits, however no interventions for these disciplines. In the chart for RRHV#3, the patient had massage therapy ordered and the frequency of visit was on the plan of care, however no interventions. Additionally, during the home visit, the patient and nurse verified that the oxygen liter flow was 4 liters per minute and had been at the rate for a while. The hospice plan of care indicated the oxygen liter flow was ordered to be at 2 liters per minute and had not been updated to reflect the change. This was verified with the RN at the visit and with the Supervisor assisting with record review. In the chart for RRNHV#5, A GIP patient, the foley catheter order was missing the size catheter/balloon on the hospice POC. The CVAD dressing change order was incomplete as it was missing the occlusive dressing cover; missing a cleansing agent. The wound care order was in the inpatient chart, however not on the hospice POC. Additionally the order was an incomplete order as it did not include the cleansing agent only the dressing and frequency. In the chart for RRNHV#8, the caregiver is regularly checking the patient's blood sugars. This treatment was not on the hospice POC. This was discussed with the Supervisor assisting with record review. Observed in Patient Home. In RRHV#5, the plan of care did not include the current home oxygen flow rate for the patient with COPD. It was documented in the hospice plan of care the patient was on oxygen 4 liters continuous per nasal cannula, but it was confirmed the patient's current ordered flow rate was 5 liters. In RRNHV#10, it was documented in the plan of care the patient's home oxygen order was 2 liters per nasal cannula, but the oxygen liter flow was indicated to be 3 liters per the medical director and RN assessments. This was reviewed and verified with the Clinical Supervisor.

Observed in Patient Home. In 1 of 21 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medical supplies and appliances necessary to meet the patient needs. In RRHV#4, the hospice general in-patient plan of care did not include complete nursing orders for the patient's indwelling Foley catheter (catheter/balloon size, frequency of changes). This was reviewed and verified with the Clinical Supervisor.

Observed in Record Review. In 1 of 21 patient records reviewed, the plan of care had not been revised based on documented progress toward goals. In the chart for RRHV#3, in each IDT for the past 10 weeks, the RN update included a statement that the patient had been started on diuretics, yet there had been no new medications or change in dosage during that time period. In addition, there was no documented progress toward goals that were expected to be met within the first two weeks of care such as pain at patient's goal for 3 consecutive days, verbalization of smoking risk with use of oxygen. The goal status simply stated progressing. This was discussed with the Supervisor assisting with record reviews.

Observed in Record Review. In 2 of 21 patient records reviewed, the patient record did not contain the following clinical information: - Any medications administered, including dose. In the chart for RNHV#8, the nurse did not fully document medication administration, Administered dose of Roxanol. In the chart for RRD/C#2, there was incomplete documentation of care, SN gave dose of Tramadol. This was verified with the Supervisor assisting with record review.

Observed in Record Review. In 1 of 21 patient records reviewed, the patient record did not include a correct medication list. In the chart for RRHV#3, Colchine was duplicated on the medication list on the plan of care as well as the list in the patient's home. This was verified with the RN assisting with making home visits.

Observed in Record Review. In 1 of 21 patient records reviewed, at the time when controlled medications were first ordered, the hospice had not documented that the written policies and procedures for managing controlled medications were provided and discussed. There was no documentation of this education in the chart for RRHV#3. This was discussed with the Supervisor assisting with record review.

Observed in Record Review. In 3 of 6 home visits conducted, the organization had not provided education and training to the patient about procedures to follow if care, treatment, or services are disrupted by a natural disaster or an emergency. During RRHV#3, it was noted by the surveyor and RN assisting with home visits that the patient did not have a copy of the individualized emergency plan in the home. The patient verified that this had not been provided during the visit. Upon discussion with the Supervisor assisting with record reviews, the organization's process is to collect this information with the patient during the initial assessment and an individualized plan is printed from the organization's EMR and provided to patients at a subsequent visit. Observed in Patient Home. In RRHV#5 and RRHV#6, there was no evidence in the home that the patient and family were provided education/information on their individualized emergency disaster plan, including the oxygen, durable medical equipment, and supplies needed and utilized by the patient. This was reviewed and confirmed with the Clinical Supervisor.