Every finding on record at Providence Health and Services- Washington

Observed in Record Review. In 5 of 10 patient records reviewed, where the patient elected to receive the Patient Notification of Hospice Non-Covered Items, Services and Drugs, the organization failed to ensure the request was fulfilled. In RRHV#1, RRHV#3, RRNHV#4, RRNHV#5, and RRNHV#6 there was documentation that the patient had elected to receive the Notification of Non-Covered Item, yet there was no documentation that the notification was completed and delivered to the patient. On discussion with Quality Management it was noted that the organization has a process for fulfilling the request within the EMR but it was noted that the process was not followed, therefore there was no documentation that the patient received the document.

Observed in Record Review. In 1 of 10 patient records reviewed, the organization failed document a patient-specific comprehensive assessment and reassessment that identifies the patient’s need for hospice care and services. For example: on review of RRNHV#7 the patient had multiple wound to the lower extremity yet there was not a comprehensive wound assessment documented on admission, and further visits documented a size and location but lacked shape, color, moisture, exudate as required by organization accepted procedure. This observation was reviewed with the Hospice Director, and Quality Management. Observed in Record Review. In 5 of 10 patient records reviewed, the organization failed to conduct and document a patient-specific comprehensive assessment and reassessment that identifies the patient’s need for hospice care and services. For example: on review of RRHV#1, RRHV#3, RRNHV#5, RRNHV#6, and RRNHV#10 there was no documentation that the need for volunteer services to offer support or respite to the patient, family, or other caregivers was assessed. This observation was reviewed with the Hospice Director, and Quality Management.

Observed in Patient Home. In 2 of 10 patient records reviewed, the organization failed to ensure the plan of care include all services needed for the palliation and management of the terminal illness and related conditions. For example: on home observation for RRHV#1 the caregiver discussed the patient's difficulty with swallowing and the use to thickened liquids to assist in swallowing, yet issues with swallowing was not noted on the plan of care. Further in RRHV#1 the documentation noted fragile skin with skin tears yet the issues were not reflected in the plan of care. In RRHV#3 the documentation noted restlessness with medication changes yet the change in patient status was not reflected in the plan of care. These observations were reviewed with the Hospice Director and the RN.

Observed in Record Review. In 4 of 10 patient records reviewed, The organization failed to ensure plan of care includes all services needed for the palliation and management of the terminal illness and related conditions. In review of RRHV#1 the patient was noted to have difficulty swallowing and discussion with caregiver and documentation noted they were using thickener in the patient's liquids, yet there were no physicians order for thickener noted on the record. On review of RRNHV#5 there were medication orders noted on medication profile that had ranges without specific instructions to guide the user on which dose to choose; such as Lorazepam take 0.25 - 1ml by mouth under tongue/in cheek every 2 hours as needed for agitation, anxiety, or nausea and Guaifenesin 100/5ml liquid - take 5-10ml by mouth every 4 hours as needed for cough. In RRNHV#10 there was also an for morphine 0.5 to 1 tab every 4 hours as needed for pain yet there were no instructions on when to choose what dose. In RRNHV#6 the documentation noted the patient was utilizing a Trilogy ventilator, yet there were no physicians orders and settings for the use of the Trilogy. These observations were reviewed with the Hospice Director, and Quality Management.

Observed in Record Review. In 3 of 10 patient records reviewed, The organization failed to ensure the registered nurse prepare written patient care instructions. For example: on home observation at RRHV#3 to observe the hospice aide it was noted that the patient was on continuous oxygen and the oxygen was removed for the duration of the patients bath. The aide plan of care did not specify oxygen precautions and how to handle the oxygen during the bath. In RRNHV# 5 the patient was also utilizing oxygen yet the aide plan of care did not address O2 precautions or how to handle oxygen during the bath. In RRNHV#7 the patient had wounds with dressing changes yet there were no instructions to guide the aide in how to handle the dressings while performing care. These observations were reviewed with the Hospice Director, and Quality Management.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to ensure the hospice aide provide services that are ordered in the plan of care For example: on home observation with the hospice aide in RRHV#3 the aide was observed to give the patient a shower in a shower chair, however the plan of care specified that a bed bath was to be provided. This observation was reviewed with the Hospice Director, Quality Management, and the hospice Aide.

Observed in Tracer Activities. During the volunteer program review session, it was noted that the organization did not provided volunteer services in 2023 as there were no active volunteers during the start of business throughout the year. This observation was reviewed with Hospice Director, Quality Management, and Volunteer services.