Every finding on record at Tennova Healthcare Hospice

Based on agency policy review, medical record review, and interview, the agency failed to complete a thorough comprehensive assessment to include the bowel status for 1 patient (#1) of 13 patients reviewed. The findings include: Review of the agency policy titled, "Comprehensive Assessment & Plan of Care," revised 4/1/2022, showed "...The registered nurse (RN) will conduct an...assessment to determine the patient's immediate care needs...including identification of goals and interventions, will include the assessment of...bowel...elimination..." Medical record review revealed Patient #1 was admitted to the agency on 1/26/2022 with diagnoses including Unspecified Dementia, Dysphagia, and Essential Primary Hypertension. Medical record review of Patient #1's Plan of Care (POC) with the certification period of 4/26/2022-7/24/2022 revealed "...SN [Skilled nurse] EFFECTIVE 4/26/2022... 2 X [times] WEEK...3 PRN [as needed]..." Medical record review of nursing clinical note dated 5/9, 5/12, 5/23, 5/28, 5/29, 6/14, 6/16, 6/28, and 7/12/2022 revealed no documentation Patient #1's bowel elimination had been assessed. During an interview on 7/20/2022 at 8:29 AM, the Executive Director (ED) confirmed a thorough comprehensive assessment to include the bowel assessment for Patient #1 had not been completed on 5/9, 5/12, 5/23, 5/28, 5/29, 6/14, 6/16, 6/28, and 7/12/2022. The ED confirmed bowel assessments should be completed and documented on each visit.

Based on agency physician standing order review, medical record review, and interview, the agency failed to implement a bowel regimen protocol for 1 patient (#2) who received opioids (pain medication) of 13 patients reviewed. The findings include: Review of the Physician Standing Orders showed patients prescribed opioids were to receive a bowel regimen protocol to include orders for medications to treat constipation. Medical record review revealed Patient #2 was admitted to the agency on 9/14/2021 with diagnoses including Coronary Artery Disease, Acute Kidney Failure, and Crohn's Disease. Medical record review of a Physician Order dated 9/14/2021, showed Patient #2 had been ordered Hydrocodone (an opioid used to treat pain) 10 milligrams every 4 hours for chronic pain. Medical record review of the medication profile summary showed Patient #2 had not been ordered medications to treat constipation. During an interview on 7/20/2022 at 11:18 AM, the Executive Director and the Regional Clinical Coordinator confirmed the agency failed to follow the physician standing orders for Patient #2 who received opioids and had not been placed on a bowel regimen protocol for constipation.

Based on agency policy review, medical record review, and interview, the agency failed to furnish services indicated by the Plan of Care (POC) related to visit frequency for 4 patients (#1, #3, #7 and #8) of 13 patients reviewed. The findings include: Review of the agency policy titled, "Plan of Care," revised 4/1/2022, showed "...The plan of care shall state in detail the scope and frequency of services needed to meet the patient's...needs..." Medical record review revealed Patient #1 was admitted to the agency on 1/26/2022 with diagnoses including Unspecified Dementia, Dysphagia, and Essential Primary Hypertension. Medical record review of Patient #1's POC for certification period 4/26/2022-7/24/2022 showed Skilled Nurse (SN) visit frequency was 2 times per week for 12 weeks. Medical record review showed Patient #1 had 1 missed SN visit for the week of 7/3/2022-7/9/2022. Medical record review revealed Patient #3 was admitted to the agency on 4/29/2022 with diagnoses including Alzheimer's Disease, Heart Failure, and Acute Respiratory Failure. Medical record review of Patient #3's POC for the certification period 4/29/2022-7/27/2022 showed the frequency for SN visits were 2 times per week for 12 weeks. Medical record review showed Patient #3 had 1 missed SN visit for the week of 5/8/2022-5/14/2022. Medical record review revealed Patient #7 was admitted to the agency on 6/21/2022 with diagnoses including Hypertensive Heart, Chronic Kidney Disease, and Type 2 Diabetes Mellitus. Medical record review of Patient #7's POC for the certification period 6/21/2022-9/18/2022 showed the frequency for SN visits were 3 times per week for 12 weeks. Medical record review showed Patient #7 had 1 missed SN visit for the week of 6/26/2022-7/9/2022 and 1 missed SN visit for the week of 7/3/2022-7/9/2022. Medical record review revealed Patient #8 was admitted to the agency on 6/2/2022 with diagnoses including Emphysema, Hypertensive Heart Disease, and Heart Failure. Medical record review of Patient #8's POC for the certification period 6/2/2022-8/30/2022 showed the frequency for SN visits were 3 times per week for 2 weeks. The frequency for Home Hospice Aide (HHA) were 2 times per week for 12 weeks. Medical record review showed Patient #8 had 1 missed SN visit for the week of 6/12/2022-6/18/2022. Medical record review showed Patient #8 and 1 missed HHA visit for the week of 6/12/2022-6/18/2022 and 1 missed HHA visit for the week 7/3/2022-7/9/2022. During an interview on 7/20/2022 at 8:29 AM, the Executive Director and Business Office Manager confirmed Patient #1 had a missed SN visit the week of 7/3/2022-7/9/2022. Patient #3 had a missed SN visit the week of 5/8/2022-5/14/2022. Patient #7 had a missed SN visit the week of 6/26/2022-7/9/2022 and 7/3/2022-7/9/2022. Patient #8 had a missed SN and HHA visit the week of 6/12/2022-6/18/2022 and had a missed HHA visit on 7/3/2022-7/9/2022. The Executive Director confirmed the agency was to follow the plan of care for visit frequency.