Every finding on record at Pheobe Sumter Medical Center, Inc

Based on observation, clinical record review and staff interview it was determined that the agency failed to ensure that patient medication profiles were updated to reflect current medications at the time of the comprehensive assessment for one of 14 patients (P) (P#3). The findings include: 1. A home visit was conducted on 10/19/21, at approximately 11:00 a.m. at the residence of P#3 with Registered Nurse (RN) #GG. The patient was admitted to hospice on 9/24/21, with the hospice diagnosis of malignant neoplasm of overlapping sites of left female breast. The clinical record was reviewed for certification period 9/24/21 to 12/22/21. The surveyor compared P#3's current medication list in the agency's electronic medical record (EMR) to the medications in P#3's medications in the home. P#3 had the following medications present in the home but not listed in the agency EMR: a. Nitroglycerin 0.4 mg (milligrams), which is used to manage chest pain symptoms. b. Gabapentin 300 mg, which is used to manage neuropathic pain symptoms. While reviewing medications in the home with RN #GG, RN #GG did verbalize understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every in-home visit. During an interview at the agency on 10/20/21, at 12:00 p.m. The Administrator was made aware that P#3's medication profile did not reflect current medications.

Based on clinical record review, it was determined that the hospice failed to ensure that the plan of care included incomplete physician's order for four of 14 sampled patients (P) (P#1, P#3, P#6 and P#9). The finding include: 1. Patient #1 was admitted to hospice on 9/18/21, with the hospice diagnosis of senile degeneration of the brain. P#1's clinical record was reviewed for the certification period 9/18/21 to 11/16/21. On 9/23/21, the following incomplete physician's orders were entered into P#1's clinical record: "wound care tombuttocks (sic) using wet to dry dressings". The wound care order lacked specific directions regarding what solution to use in wet dressing, how to secure the dressing and how often to perform the dressing change. The order also lacked specification of who was responsible for the wound care dressing changes. 2. Patient #3 was admitted to hospice on 9/24/21, with the hospice diagnosis of malignant neoplasm of overlapping sites of left female breast. P#3's clinical record was reviewed for the certification period 9/24/21 to 12/22/21. On 9/24/21, the following physician's standing order was entered into P#3's clinical record: "Dyspnea: Oxygen 2 Liters per nasal cannula prn or continuous and/ or Lorazepam Ativan 1 mg (milligram) (used for anxiety or seizure disorder) po (by mouth) tid (three times daily) prn (as needed). May increase O2 (oxygen) 4 L/m (liters per minute) if needed". During a home visit with P#3 and RN#GG at 11:00 a.m. on 10/19/21, surveyor noted P#3's oxygen concentrator was at one liter. During the home visit, RN#GG verbalized awareness of the setting and confirmed that the oxygen concentrator was correctly set to one liter. However, there was no order in the clinical record to set the oxygen flow at one liter. 3. Patient #6 was admitted to hospice on 6/18/21, with the hospice diagnosis of cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery. P#6's clinical record was reviewed for the certification period 9/16/21 to 12/14/21. The clinical record revealed the following physician's orders: a. On 6/18/21, the following standing order was entered into the clinical record: "Insert or change indwelling catheter- may irrigate prn with normal saline solution." During a home visit with P#6 on 10/19/21, at 9:30 a.m. with Registered Nurse (RN) #HH, patient was noted to have a Foley catheter. However, P#6's clinical record did not have a specific order stating size of Foley catheter or size of balloon to be inserted. The clinical record also lacked a specific order stating how often to change the Foley catheter. b. During a home visit with P#6 on 10/19/21, at 9:30 a.m., the surveyor observed RN #HH provide wound care to P#6's left heel, lateral aspect of left distal lateral foot and left calf. RN#HH was noted to provide wet to dry dressings for each wound on the left heel, left distal lateral foot and left calf, using half Dakin's solution for wet dressing, placing dry gauze, wrapping with kurlex and securing with Medi pore tape. The clinical record contained the following incomplete order for these wounds: "Dakin's solution wet to dry dressings daily to wounds on left distal lateral foot left heel and left posterior leg. Nurse may do on scheduled visits and family or hired caregiver to do on other days". RN #HH was observed using the incorrect solution for wet dressing during the home visit. Additionally, the order in the clinical record was incomplete in that it did not specify how to secure the dressing or how to clean the wound before the new dressing was applied. c. During a home visit with P#6 on 10/19/21, at 9:30, RN #HH was observed providing wound care to P#6's coccyx. RN #HH was observed cleaning the wound with normal saline, applying a wet dressing soaked with half Dakin's solution, covering with dry gauze and securing with Medi pore tape. P#6's clinical record did not have any orders to provide wound care to wound located on the coccyx. 4. Patient #9 was admitted to hospice on 9/6/21, with the hospice diagnosis of senile degeneration of the brain. P#9's clinical record was reviewed for the certification period 9/6/21, to 12/4/21. The clinical record contained a care plan titled "Plan of Care Collaboration due to comprehensive assessment needs identification r/t senile degeneration of brain, wt (weight) loss, DTI (deep tissue injury) to both heels and coccyx." However, review of P#9's clinical record revealed that there were no physician's orders present to care for the DTI's identified by the care plan and the comprehensive nursing assessment performed on 9/6/21. During interview on 10/20/21, at 12:00 p.m. at the agency, the Administrator was made aware of the presence of incomplete physician's order for (P#1, P#3, P#6 and P#9).