Every finding on record at Pruitthealth Hospice, Inc.

Based on record review, family and staff interview, and review of policy ";Patient Rights and Responsibilities for Hospice," it was determined that the agency failed to protect and promote the patients right to receive effective pain management and symptom control for conditions related to their terminal illness for one patient (P) (P#1) of three sampled patients. --- Findings include: Review of the policy titled ";Patient Rights and Responsibilities for Hospice," revised 12/4/2017 revealed that the patient has the right to receive effective pain management and symptom control for conditions related to their terminal illness. Review of the complaint and on-call logs revealed that the family member of P#1 called on 8/14/2024 at 8:25 pm to report that P#1s heart rate was extremely high. The on-call log revealed that the caregiver was unable to obtain a blood pressure reading and the pulse was elevated. The on-call log revealed that the on-call nurse triaged over the phone, stating to reposition the patient and administer pain medication. At 8:29 pm the on-call log revealed that P#1s pulse had returned to baseline and no further action was required. The agency failed to send a nurse to assess the patients' symptoms or to provide pain management. The Skilled Nurse Visit Note dated 8/15/2024 revealed that P#1 was grimacing, heart rate was 81 beats per minute (A normal resting heart rate for adults ranges from 60 to 100 beats per minute) and regular. Registered Nurse (RN) recommended to increase pain meds, the family member refused, and P#1 family member was educated on comfort care. During an interview on 10/29/2024 at 10:37 a.m., with family member of P#1, family member confirmed that agency did not send a nurse out for a visit when P#1 had a tachycardia episode until the next day. During an interview with the Assistant Administrator on 10/29/2024 at 11:15 a.m., it was confirmed that on 8/14/2024 at 8:25 p.m., that the on-call nurse triaged the call for P#1 over the phone and did not send a nurse to assess P#1 within one hour of the call. She confirmed that the next visit was completed on 8/15/2024 at 2:58 p.m.

Based on record review, family member and staff interview, and review of policy ";Patient Rights and Responsibilities for Hospice," it was determined the agency failed to protect and promote the patients right to refuse care or treatment for one patient (P) (P#1) of three sampled patients. --- Findings include: Review of the policy titled ";Patient Rights and Responsibilities for Hospice," revised 12/4/2017 revealed that a patient has the right to accept or refuse treatment to the extent permitted by law, without severing your relationship with the hospice and to be informed of the medical consequences of this action. Review of laboratory results for P#1 dated 8/16/2024 revealed results of an elevated Troponin level (a protein found in the blood after the heart has experienced damage). Record review revealed that a document titled ";Refusal of Care: Against Medical Advice Form (AMA) was signed by the family member of P#1 on 8/20/2024. The AMA revealed that P#1s family member was refusing to go to the emergency room with P#1 after being advised by the Medical Director. During an interview with the family member of P#1 on 10/29/2024 at 10:37 a.m., confirmed that she was asked to sign an ";Against Medical Advice Form" (AMA) when she refused to take P#1 to the hospital after receiving the lab results for an elevated Troponin level. She stated that she initially refused to sign it because the agency had added untrue statements but once the statements were removed, she did comply and signed. She states that she did not understand why she was being asked to sign a Refusal of Care: Against Medical Advice Form (AMA). The family member stated that she consulted with the emergency department and was told since P#1 was already on hospice that the agency should just make her comfortable at home rather than have her go through the stress of a hospital admission. During an interview with the Assistant Administrator on 10/29/2024 at 11:15 a.m., it was confirmed that it was recommended by the agencys Medical Director that P#1 be sent to the hospital after receiving the elevated Troponin level (a protein found in the blood after the heart has experienced damage). The Assistant Administrator stated that when the family refused to take P#1 to the hospital for the elevated Troponin level, the agency asked her to sign a AMA form.

Based on clinical record review and staff interview, it was determined the hospice failed to develop and maintain a system of communication and integration that ensured the interdisciplinary group maintained responsibility for directing, coordinating, and supervising the care and services provided for 1 of 7 active sampled patients (P#4). The finding include: 1. Review of the clinical record for P #4 with a recertification period of 4/20/22 to 6/18/22 and a diagnosis of Alzheimer's Disease revealed an order for the skilled nurse (SN) to visit the patient 1 time a week for nine weeks. Review of the record indicated the SN only visited the patient 2 times in the month of May, on 5/6 and 5/26/22. The clinical record did contain a missed visit note dated 5/6/22 indicating the SN did not visit the patient on 5/6/22 however, the SN did not provide a reason as to why the visit was not made. The SN also failed to visit the patient the week of 5/15/22 and documented the visit was missed due to the SN being ill. Additionally, the SN failed to visit the patient the week of 5/29/22 and documented the visit was missed due to a scheduling conflict. It is unclear if the scheduling conflict was related to the patient or to the clinician. The clinical record lacked documentation of coordination of care with team members to assign another SN to perform the visits when the initial SN was unable to complete the visits as ordered to ensure the patient received the services ordered for proper care and safety of the patient. 2.During an interview with the Director of Health Services (DHS) on 6/8/22, at approximately 11:00 a.m., the DHS acknowledged the clinical record lacked documentation of care coordination efforts with the team to assign a different staff person who could assist with providing services for the identified needs of the patient.