Every finding on record at Pruitthealth Hospice, Inc.

Based on observations, clinical record reviews, and staff interviews, the agency failed to ensure medication profiles for one (1) of thirteen (13) patients (P#4) were updated to reflect current medications at the time of the comprehensive assessment. The findings include: During a home visit on 10/26/21, at approximately 12:10 p.m., with Registered Nurse (RN) AA, the surveyor reviewed P#4's clinical record for the certification period of 9/12/21 to 11/10/21. Review of the medical record revealed diagnoses that include Alzheimer's disease, dementia, and hypertension. When comparing the medications that P#4 was taking at home with the agency's current medication profile and plan of care, it revealed that there was no match. P#4's daily medications were packed together with two expired medications, and one of the medications (Diazepam) was not even listed in hospice agency medication profile and plan of care: 1. Diazepam milligrams (MG) give half tablet by mouth every day as needed for anxiety, Diazepam was not listed in agency medication profile and plan of care. The medication was filled on 12/16/19, and expired on 12/16/20. 2. Hyoscyamine 0.125 mg sublingual give one tablet under the tongue every four hours as needed for secretions. The medication was filled on 1/17/20, and expired on 1/17/21. On 10/26/21, at 12:52 p.m., an interview was conducted with a Registered Nurse (RN) AA, who stated he was assigned case manager to P#4. (RN) AA, stated that he was not aware that P#4's listed medications had expired.

Based on observations, clinical record reviews, and staff interviews, the agency failed to ensure plan of care for one (1) of thirteen (13) patients (P#4) was updated to reflect current medications. The findings include: During a home visit on 10/26/21, at approximately 12:10 p.m., with Registered Nurse (RN) AA, P#4's clinical record for the certification period of 9/12/21 to 11/10/21 was reviewed. P#4's diagnoses included, Alzheimer's disease, dementia, and hypertension. When comparing the medications P#4 was taking at home with the agency's current plan of care, revealed the daily medications did not match. One of the medications (Diazepam) was not listed in hospice agency medication plan of care: 1. Diazepam 2 milligrams (MG) give half tablets by mouth every day as needed for anxiety, Diazepam was not listed in agency medication plan of care. The medication was filled on 12/16/19, and expired on 12/16/20. 2. Hyoscyamine 0.125 mg sublingual give one tablet under the tongue every four hours as needed for secretions. The medication was listed and was filled on 1/17/20 and expired on 1/17/21. On 10/26/2,1 at 12:52 p.m., an interview was conducted with a Registered Nurse (RN) AA, who stated he was assigned case manager to P#4. (RN) AA, stated that he was not aware that P#4's listed medications had expired.

Based on clinical record review, observations, staff interview and review of the hospice agency's Policy, it was determined that the agency failed to ensure their procedure was implemented prior to considering the use of a hospital bed with full siderails. The agency failed to incorporate monitoring and specific safety measures in the "Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update Report". The agency also failed to ensure a complete physician order for the use of full bedrails was obtained for one (1) of thirteen (13) patients (P#4) receiving hospice services. The findings include: Patient #4 was re-admitted to hospice on 1/16/21, with diagnoses to include Alzheimer's disease, dementia and hypertension. Review of the clinical record, it was discovered on 9/7/21 a physician's order for "Hospital Bed with Bedrails" was obtained, the order did not specify the reason for the device, nor could the agency provide consent for the use of bedrails from the family. On 9/11/21, Registered Nurse RN (AA) documented a late entry note for a visit made on 9/9/21. It is noted on the late entry "Visit Note Report" page 2 of 4 the patient had a recent decline in functioning and on page 8 of 9 item #4 it is noted under assessed patients' functional status in relationship to potential safety hazards in patients living area detail /and comments; included, "safe use of bedrails. Review of the agency's form, titled "Visit Note Report" dated 9/14/21 , 9/17/21, 9/21/21, 9/24/21, 9/28/21, 9/30/21, 10/8/21, 10/15/21, 10/19/21 and 10/22/21, did not include full bedrail use, specific ongoing monitoring of the full bedrails , family education, care plan updates and/ or safety precautions related to the use of full bedrails. Review of the agency's form titled, " Hospice IDG Comprehensive Assessment and Plan of Care Update Report", the IDG notes dated 9/17/21, revealed a DME (Durable Medical Equipment), Hospice Bed with Bed Rails. Further review of IDG notes dated 10/1/21 and 10/15/21, the use of bedrails were not included in the IDG meeting notes. On 10/26/21, at 12:48 p.m., an interview was conducted with RN AA, who stated he ordered the hospital bed with full side rails for P#4 last month when P#4 declined in health. RN AA said that he did not know how he missed to document teaching related to the hospital bed with full side rails in the nursing notes. Registered Nurse AA ordered a hospital bed with full bedrails without documenting teaching the patient, family, or caregiver. During an interview at the agency on 10/26/21, at 1:00 p.m., the Director of Nursing (DON) confirmed that RN AA did not document teaching to patient, family and caregiver related to the hospital bed with full side rails in nursing notes. There was no documentation to support the agencies policy titled "Use of Physical Restraints and Enablers for Hospice" revised on 11/01/2019 and reviewed on 12/07/2020, which indicated a physician order will be written to state that the device is for "safety" (a restraint) or for "positioning," etc. (an enabler)." During a telephone interview with the DON on 11/8/21, at approximately 10:00 a.m., the DON was not able to provide documented evidence of a signed consent for P#4's family regarding the use of bedrails. The DON provide the caller via an email a Physician order clarification dated 10/27/21. The order noted "Bedrails to define bed parameters, to help provide patient safety, and assist with bed mobility.

Based on clinical record review and staff interview, it was determined that the agency failed to a obtain a physician's order for a hospital bed with bed rails for one (1) of thirteen (13) patients (P#4) receiving hospice services. The findings include: Review of the initial Skilled Nurse (SN) assessment and Plan of Care (POC) dated 10/25/21, revealed P#4 had hospital bed with full side rails due to patient's decline in health. Patient #4 was admitted to hospice on 1/16/21, with a diagnosis of Alzheimer's disease, dementia, and hypertension. Review of the clinical record, it was discovered that Registered Nurse (RN) AA ordered an hospital bed with full side rails for P#4 without obtaining a physician's order. On 10/26/21, at 12:48 p.m., an interview was conducted with RN AA, who stated that he ordered the hospital bed with full side rails for P#4 last month when P#4 declined in health. RN AA said that he did not know how he missed to obtain physician's order for hospital bed with full side rails. During an interview on 10/26/21, at 1:00 p.m., the Director of Nursing (DON) confirmed that RN AA did not obtain physician's order for hospital bed with full side rails for P#4.