Every finding on record at Peachtree Hospice of Georgia, LLC

Based on record reviews and staff interviews, it was determined the hospice failed to ensure that patient and primary caregiver received training and education provided by the agency as appropriate for their responsibilities for care and services for two patients (P) (P12, P13) of 20 patients sampled. --- Findings include: 1. Record review reveals P12 was admitted to hospice on 3/19/2024 with a diagnosis of hypertensive heart disease with heart failure (a long-term condition that develops over many years in people who have high blood pressure and the heart muscle doesn't pump blood as well as it should). Review of a document dated 3/19/2024, titled, ";Hospice Certification and Plan of Care", reveals P12 was admitted to home hospice on a Milrinone drip (a drug that treats heart failure by increasing the strength of heart muscles and widening blood vessels), infusing through a PICC line (a peripherally inserted central catheter that is a thin, flexible tube inserted into a vein in the upper arm and threaded into a large vein in the chest) in the right upper arm and a PleurX catheter (a flexible tube that drains excess fluid from the pleural space, the area between the lung and chest wall), site not specified. Review of the ";Orders of Discipline and Treatments" on the Hospice Certification and Plan of Care reveals the following: · ";Hospice nurse to instruct regarding infusion procedure: Milrinone 400mcg/ml to infuse @ (at) 3.2ml/hr via right upper arm PICC line. Flush with 3cc Heparin (anticoagulant (blood thinner) that prevents the formation of blood clots) daily, care and use of equipment, record keeping, infusion pump, and signs/symptoms of infection/ infiltration/complications/phlebitis." · ";Hospice nurse to instruct/ perform care of PleurX drainage tube site, draining procedure and frequency" Review of Coordination Notes and Visit Notes failed to reveal patient or caregiver education on Milrinone, PICC line care, or the PleurX catheter. 2. Record review reveals P13 was admitted to hospice on 5/13/2024 with a diagnosis of heart failure (when the heart muscle doesn't pump blood as well as it should). Review of a document titled, ";Hospice Certification and Plan of Care," dated 5/13/2024 reveals P13 was admitted to home hospice with a Milrinone drip, infusing through a PICC line in the right upper arm. Review of the ";Orders of Discipline and Treatments" on the Hospice Certification and Plan of Care reveals the following: ";Hospice nurse to instruct regarding infusion procedure: Milrinone 20 mg/100ml (200mcg/ml) infusing @ 2.7ml/hr via right upper arm PICC line. Instruct in care of line, flush PICC line with 100cc of SNS with each Milrinone bag change, care and use of equipment, record keeping, infusion CADD pump, operation, and signs/symptoms of infection/ infiltration/complications/phlebitis." A review of Coordination Notes and Visit notes revealed the clinical record failed to reveal patient or caregiver education on Milrinone or care of the PICC line. On 9/9/2024 at approximately 2:00 pm, an interview with the Regional Vice President of Operations (RVPCO) revealed patients with PleurX catheters are given a package insert from the drainage kit to instruct and educate them on how and when to use the drainage catheter. The RVPCO confirmed that any patient/caregiver education provided should be documented in the clinical record. On 9/11/2024 at approximately 10:00 am, an interview with Clinical Managers (CM) A and B revealed teaching about Milrinone begins at the hospital before admission to home hospice. On admission, all patients are told to call the hospice for any problems. CM AA and BB confirmed that the PleurX package insert is routinely provided to patients with PleurX catheters and confirmed that all patient education provided should be documented in the clinical record.

Based on record reviews, staff interviews, and review of policies titled ";Verification of Physician Orders," and ";Interdisciplinary Group Plan of Care," it was determined the hospice failed to develop an individualized plan of care that includes all services necessary for the management and palliation of the terminal illness and related conditions for two patients (P) (P12, P13) of 20 sampled patients. --- Findings include: Review of the policy titled ";Verification of Physician Orders," Policy No. 4-028.1, revised November 2018, reveals the following: Policy Orders will be obtained from a licensed physician (or other authorized independent practitioner) for care and services to be provided to hospice patients. Review of the policy titled ";Interdisciplinary Group Plan of Care," Policy No. 4-031.1, revised November 2018, reveals the following: Policy The type and scope of services provided by the interdisciplinary group will be based upon comprehensive and ongoing assessments regarding the needs of the patient and family/caregiver and the comprehensive plan of care that defines patient and family/caregiver problems, goals and interventions 1. P12 was admitted to hospice on 3/19/2024 with a diagnosis of hypertensive heart disease with heart failure (a long-term condition that develops over many years in people who have high blood pressure and the heart muscle doesn't pump blood as well as it should). Review of a document titled, ";Hospice Certification and Plan of Care," dated 3/19/2024 reveals P12 was admitted to home hospice with a Milrinone drip (a drug that treats heart failure by increasing the strength of heart muscles and widening blood vessels), infusing through a PICC line (a peripherally inserted central catheter that is a thin, flexible tube inserted into a vein in the upper arm and threaded into a large vein in the chest) in the right upper arm and a PleurX catheter (a flexible tube that drains excess fluid from the pleural space, the area between the lung and chest wall), site not specified. Review of the ";Orders of Discipline and Treatments" on the Hospice Certification and Plan of Care reveals the following: · ";Hospice nurse to instruct regarding infusion procedure: Milrinone 400mcg/ml to infuse @ 3.2ml/hr via right upper arm PICC line. Flush with 3cc Heparin daily, care and use of equipment, record keeping, infusion pump, and signs/symptoms of infection/ infiltration/complications/phlebitis." · ";Hospice nurse to change central line dressing per physician/agency protocol" · ";Hospice nurse to instruct/ perform care of PleurX drainage tube site, draining procedure and frequency" · The clinical record failed to reveal specific physician orders prescribing care of the PICC line or frequency of dressing changes. The clinical record lacks specific physician orders related to the care and maintenance of the PleurX tube and insertion site, frequency of draining or dressing changes, or parameters for notifying the physician or draining. 2. P13 was admitted to hospice on 5/13/2024 with a diagnosis of heart failure (when the heart muscle doesn't pump blood as well as it should). Review of document titled, ";Hospice Certification and Plan of Care," dated 5/13/2024, reveals P13 was admitted to home hospice with a Milrinone drip, infusing through a PICC line in the right upper arm. Review of the ";Orders of Discipline and Treatments" on the Hospice Certification and Plan of Care reveals the following: · ";Hospice nurse to change central line dressing per physician/agency protocol" · ";Hospice nurse to flush IV access with 10 cc of NS with each dressing change using aseptic technique". · ";Flush PICC line with 10 cc of SNS with each Milrinone bag change" The clinical record failed to reveal specific physician orders prescribing care of the PICC line or frequency of dressing changes. On 9/9/2024 at approximately 2:00 pm, an interview with the Regional Vice President of Operations (RVPCO) revealed nurses use a Lippincott Manual of Nursing Practice to guide nursing care for central lines. The RVP of CO revealed patients with PleurX catheters are given a package insert from the drainage kit as instructions and education on how and when to use the drainage catheter. The RVPCO agreed that specific physician orders need to be in the clinical record for both PICC line care and PleurX catheter use. On 9/11/2024 at approximately 10:00 am, an office interview was conducted with Clinical Managers (CM) A and B, who revealed nurses provide PICC line care weekly. They agreed the physician orders were not specific and individualized for each patient.

Based record review, staff interviews, and review of policy and procedures, it was determined the agency failed to provide a pain pump for medication in a timely manner for one Patient (P) (P#1) of three sampled patients (P#1, P#2, P#3). --- The Findings include: Record review revealed patient was admitted to the hospice agency on 12/23/2001 with a diagnosis of malignant neoplasm of pancreas (cancer of pancreas, an organ which is behind the lower part of the stomach), and unspecified cerebral infarction (brain lesion in which a cluster of brain cells die when they don't get enough blood). On 3/6/2023 at 11:58 a.m., this surveyor reviewed records which revealed Morphine (pain medication) and Ativan (used for anxiety) were administered as ordered, but P#1 continued to vomit the foods and drinks. The daughter of P#1 requested pain pump on 12/24/2021 to administer pain medication to P#1, who was unable to retain foods or drinks due to nausea and vomiting. The pharmacy failed to deliver the pain pump until 12/27/2021. On 3/6/2023 at 1:00 p.m., an interview was conducted with Registered Nurse (RN) AA, who revealed that she visited P#1 on 12/24/2021 at 10:52 a.m. RN AA revealed that P#1 was having nausea and vomiting and could not hold or retain foods or drink. RN AA revealed that P#1s daughter requested pain pump to control the symptoms of distress caused by pain, nausea and vomiting. RN AA stated that she called the physician on-call to report P#1s change in condition, but the on-call physician revealed that she did not have access to her computer to send the order to the pharmacy. RN AA called another physician to send the pain pump order to the pharmacy. On 3/7/2021 at 10:00 a.m., an interview was conducted with Administrator who revealed that the hospice agency did not have a policy that specifies timeframe for pain pump delivery. The Administrator confirmed that the pain pump was delivered on 12/27/2021. The Administrator additionally revealed that the hospice agency changed P#1 to continuous care, administered Morphine, Ativan and Haldol (antipsychotic) until they received the pain pump, and increased the visits until patient expired. Additionally, the Administrator revealed that the hospice agency placed comfort kits in patient homes from the first day of admission; this was confirmed by the admission nurse RN BB. The hospice agency failed to provide a policy and procedure relating to timeframe for delivery of pain pumps. The complaint was substantiated with deficiencies cited due to delay in providing pain pump.