Every finding on record at Quality Hospice

Based on agency physician standing order review, medical record review and interview, the agency failed to implement a bowel regimen protocol for 3 patients' (#3, #9, and #8) who received opioids (pain medication) of 14 patients reviewed. The findings include: Review of the Physician Standing Orders showed all patients who are prescribed opioids will receive medication for constipation. Medical record review revealed Patient #3 was admitted to the agency on 2/8/2022 with diagnoses of Lung Cancer, Chronic Obstructive Pulmonary Disease and Thyroid Cancer. Record review of a Physician Verbal Order dated 4/27/2022, showed Patient #3 had been ordered an opioid for pain. Record review of the medication profile summary showed Patient #3 had not been ordered constipation medication. Medical record review revealed Patient #9 was admitted to the agency on 3/9/2022 with diagnoses of Hemiplegia, Constipation, and Hypertension. Record review of a Physician Verbal Order dated 3/9/2022, showed Patient #9 had been ordered an opioid for pain. Record review of the medication profile summary showed Patient #9 had not been ordered constipation medication. Medical record review revealed Patient #8 was admitted to the agency on 5/18/2022 with diagnoses of Heart Disease, Chronic Kidney Disease, and Chronic Pain Syndrome. Record review of a Physician Verbal Order dated 5/25/2022, showed Patient #8 had been ordered an opioid for pain. Record review of the medication profile summary showed Patient #8 had not been ordered constipation medication. During an interview on 6/8/2022 at 9:16 AM, the Quality Coordinator confirmed the agency failed to follow the physician standing orders for Patients #3, #9, and #8 who received opioids and had not been placed on a bowel regimen for constipation. During an interview on 6/8/2022 at 11:11 AM, the Administrator confirmed the facility failed to initiate a standing physician order for a bowel protocol to Patients #3, #9, and #8 who received opioids.

Based on agency policy review, medical record review and interview, the agency failed to complete thorough comprehensive assessments, to include wound measurements for 1 patient (#6) of 14 patients reviewed. The findings include: Review of the agency policy titled, "Wounds Assessment, Documentation, and Photographing," with a revised date of 9/6/2013, showed "...To provide wound assessment documentation guidelines and identify parameters of wound assessment...Documentation should include...Measurement of wound size..." Medical record review revealed Patient #6 was admitted to the agency on 5/11/2022 with diagnoses of Chronic Obstructive Pulmonary Disease, and Pulmonary Embolism. Record review of Patient #6's Initial Comprehensive Nursing Assessment dated 5/12/2022, showed an unstageable wound to the coccyx. No documentation of wound measurements. Record review of a Hospice Nursing Clinical Note dated 5/13/2022, 5/16/2022, 5/18/2022, 5/20/2022, 5/23/2022, 5/25/2022, and 5/27/2022, showed no documentation Patient #6's wound had been measured. Record review of a nursing Visit Note Report dated 5/31/2022, showed "...coccyx...9cm...5cm..." Record review of a nursing Visit Note Report dated 6/8/2022, showed "...coccyx....5cm...3cm...1cm..." During an interview on 6/8/2022 at 9:39 AM, the Quality Coordinator confirmed Patient #6's wound had not been measured on 5/13/2022, 5/16/2022, 5/18/2022, 5/20/2022, 5/23/2022, 5/25/2022, and 5/27/2022. During an interview on 6/8/2022 at 11:13 AM, the Administrator confirmed wounds are to be assessed and measured weekly.