Every finding on record at Physician's Choice Hospice LLC

Based on observation, interview and record review, the hospice agency failed to ensure a suction machine was available for the patient as per physicians order, for one of 11 sampled patients (Patient 2). This deficient practice can place the patients at risk of respiratory distress due to inability to clear the airway when needed. --- A review of Patient 2's clinical record indicated the patient started hospice care on 5/24/22, with a primary diagnosis of atherosclerotic heart disease (heart condition caused by hardened arteries which can cause a heart attack) of native coronary artery. A review of the Plan of Care (POC)/Interdisciplinary group (IDG) Review dated 5/24/2022 indicated the Skilled Nurse (SN) visit was 1-2 times a week, the hospice aide (HA) was to visit three times a week, the Medical Social Worker (MSW) and the spiritual counselor (SC) visit was once to assess. A review of the Comprehensive Nursing assessment dated 5/24/2022 indicated Patient 2 was alert and oriented, non-ambulatory, and needed maximum assist. Patient 2 had mild dyspnea with speech, had dry/non-productive cough, and oxygen therapy 2-4 liters per minute as needed. A review of the POC Summary indicated the physician ordered suction machine on 5/24/2022 for removal of excessive oral secretions. During a joint home visit with Registered Nurse 1 (RN 1) on 11/3/2022, at 11:15 a.m., Patient 2 was observed lying in a hospital bed, and Caregiver 1 was seated next to her bed. Patient 2 was awake but did not answer when the Surveyor greeted/questioned. An oxygen concentrator was observed next to the patient. There was no suction machine observed at the bedside. During an interview with Caregiver 1, she stated the agency did not provide the suction machine. She stated she would love to have a suction machine ready because Patient 2 had an incident of choking recently. During an interview with the Director of Patient Care Services (DPCS) designee on 11/4/2022, at 11:15 a.m., she stated the suction machine should have been provided to Patient 2 when the physician ordered. A review of the agency's policy titled, "Physician Orders" revised in 2014 indicated care and services including equipment, supplies will be provided according to the physician orders.

Based on observation, interview and record review, the hospice agency (HA) failed to ensure all care services in the individualized plan of care were followed, for one of 11 sampled patients (Patient 2). This deficient practice resulted in the patients not receiving the care/services needed and placed the patients at risk for further complications. --- A review of Patient 2's clinical record indicated the patient started hospice care on 5/24/22, with a primary diagnosis of atherosclerotic heart disease (heart condition caused by hardened arteries which can cause a heart attack) of native coronary artery. A review of the Comprehensive Nursing assessment dated 5/24/2022 indicated Patient 2 was alert and oriented, non-ambulatory, and needed maximum assist. Patient 2 had a foley catheter [16 French (F)/10 cubic centimeter (cc) balloon) inserted, to drain urine from the bladder]. Patient 2s urine was cloudy amber color and had odor. A review of the Plan of Care (POC)/Interdisciplinary group (IDG) Review dated 5/24/2022 indicated the Skilled Nurse (SN) visit was 1-2 times a week, the hospice aide (HA) was to visit three times a week, the Medical Social Worker (MSW) and the spiritual counselor (SC) visit was once to assess. The POC/IDG review indicated the SN will flush the foley catheter with 0.25 % acetic acid 50 ml every week and as needed for increased sedimentation. The physicians order dated 5/24/2022 indicated to flush the foley catheter with 50 milliliters (ml) of Acetic Acid 0.25 % solution every week and as needed for increased sedimentation for bladder irrigation. The order was changed on 8/30/2022 to flush the foley catheter with 60 – 120 ml of Acetic Acid 0.25 % two times a week and as needed for increased sedimentation. During a joint home visit with Registered Nurse (RN) 1 on 11/3/2022, at 11:15 a.m., Patient 2 was lying in a hospital bed with foley catheter in place. There was sedimentation observed in the urinary drainage tubing. At 12 p.m., there was an opened bottle of Acetic Acid (500 ml), undated (barely left in the bottle), and a bottle of normal saline (500 ml) dated 10/31/2022 observed at the patients house. During an interview with RN 1, she stated sometimes the agency staff used normal saline for flushing the foley catheter when Acetic Acid was not available. A review of the SN Visit Note for the week from 7/3/2022 to 7/9/2022 did not indicate a documented evidence Patient 2s Foley catheter was flushed. A review of the SN Visit Note dated 10/23/2022 indicated the SN flushed the catheter with 120 cc of normal saline. During an interview with the Director of Patient Care Services (DPCS) designee on 11/7/2022, at 10:50 a.m., she was not able to provide the documented evidence Patient 2s foley catheter was flushed from 7/3/2022 to 7/9/2022. The DPCS designee stated the SN should have flushed Patient 2s foley catheter from 7/3/2022 to 7/9/2022. She also stated the SN should have flushed the foley catheter with acetic acid solution as ordered, not normal saline. A review of the agency's policy titled, "Physician Orders" revised in 2014 indicated the total plan of care will be reviewed and signed by the attending physician, Medical Director of Hospice IDG involved in the patients care. It indicated the care and services will be provided according to the physician orders.

Based on observation, interview and record review the hospice agency (HA) failed to follow accepted standards of practice to prevent the urinary tract infection (UTI) for one of 11 sampled patients (Patient 2). This deficient practice had potential of placing the patient at risk of urinary tract infection (UTI). --- A review of Patient 2's clinical record indicated the patient started hospice care on 5/24/22, with a primary diagnosis of atherosclerotic heart disease (heart condition caused by hardened arteries which can cause a heart attack) of native coronary artery. A review of the Comprehensive Nursing assessment dated 5/24/2022 indicated Patient 2 was alert and oriented, non-ambulatory, and needed maximum assist. It indicated that Patient 2 had a foley catheter [16 French (F)/10 cubic centimeter (cc) balloon) inserted, and the urine was cloudy amber color and with odor. A review of the Plan of Care (POC)/Interdisciplinary group (IDG) Review dated 5/24/2022 indicated the Skilled Nurse (SN) visit was 1-2 times a week, the hospice aide (HA) was to visit three times a week, the Medical Social Worker (MSW) and the spiritual counselor (SC) visit was once to assess. The POC/IDG review indicated the SN will flush the foley catheter with 0.25 % acetic acid 50 ml every week and as needed for increased sedimentation. A review of Patient 2s clinical record indicated the patient had history of UTI as follows: 1. 5/24/2022 – The physician ordered Ciprofloxacin Hydrochloride 500 mg two times a day for 7 days. 2. 9/7/2022 – Bactrim DS 800-160 mg two times per day for 7 days 3. 9/28/2022 – Bactrim DS 800 -160 mg two times per day for 7 days The physicians order dated 5/24/2022 indicated to flush the foley catheter with 50 milliliters (ml) of Acetic Acid 0.25 % solution every week and as needed for increased sedimentation for bladder irrigation. The order was changed on 8/30/2022 to flush the foley catheter with 60 – 120 ml of Acetic Acid 0.25 % two times a week and as needed for increased sedimentation. During a joint home visit with Registered Nurse (RN) 1 on 11/3/2022, at 11:15 a.m., Patient 2 was lying in a hospital bed with foley catheter in place. There was sedimentation observed in the urinary drainage tubing. During an interview with RN 1 on11/2/2022, at 11:30 a.m., she stated the agency staff had been flushing the foley catheter two times a week, but had been changing the foley catheter and drainage bag once a month and as needed. During an interview with the Director of Patient Care Services (DPCS) and the designee DPCS on 11/7/2022, at 11:10 a.m., they stated the agency had been changing the foley catheter and the drainage bag monthly while the patient's foley catheter and the drainage tubing had been disconnected two times a week for flush. Both the DPCS and the Designee DPCS were not aware the need of maintaining a closed urinary drainage system. A review of the ";Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009" by the Center for Disease Control and Prevention (CDC) indicated, 'If breaks in aseptic technique, disconnection, or leakage occur, replace the catheter and collecting system using aseptic technique and sterile equipment'.

Based on interview and record review, the hospice agency failed to maintain medical supplies with an acceptable expiration date, stored in the agency office, and used on active patients. This failure had the potential to be less effective if used. --- During an observation on 11/7/2022 at 10:20 a.m., the following expired medical supplies were observed in agencys storage room: 1) Amsino - enteral feeding flat top piston syringe expired 7/4/2021 2) Dynarex - protective barrier wipes expired 10/2018 3) Dynarex – protective dressing applicators expired 6/2021 4) Dynarex – povidone-iodine prep pads expired 12/2021 5) BH supplies – disposable 10ml/cc syringe expired 11/ 2020 6) Coviden – flush syringe, 10 ml expired 12/2019 During an interview on 11/7/2022 at 10:35 a.m., the Director of Patient Services (DPCS) designee, stated that all supplies should be checked to ensure the expiration dates are within useable dates. DPCS further stated that if supplies are out of date, it could possibly affect the efficacy of the item being used. DPCS also stated supplies are checked and these items should not have been in the supply room due to expired dates. A review of the agencys policy ";supply maintenance" with a revised date of 2014 indicated that all supplies will be checked for expiration date prior to use. If outdated, the supplies will be immediately removed from stock and discarded.