Every finding on record at The Medical Team, Inc. - Brownsville

Observed in Record Review. In 8 of 10 patient records reviewed, The hospice nurse surveyor noted (RR#1) that none of the care plan goals included outcome measures or time frames. For example the plan of care goal stated pain will be managed at a level acceptable to the patient and patient will verbalize reduction or relief of cardiopulmonary symptoms. In (RR#2) the goals were not measurable and did not include time frames for achievement of outcomes. In (RR#3) the goals did not include any outcome measures or time frames , for example, adequate evacuation of bowel and verbalized improved comfort level and anxiety/agitation minimized. In (RR#4) there were no measurable outcomes for symptom management of dyspnea, constipation, seizures and nausea, vomiting and wounds; the goals stated patient will have adequate evacuation of bowel, Anxiety/agitation is minimized/controlled, caregiver will verbalize/demonstrate appropriate and safe wound care. Also there were no respiratory or nausea and vomiting goals for issues identified in the interdisciplinary notes. In (RR#6) there were no outcome measures or time frames and in (RR#8) there were no outcome measures to manage pain, constipation, dyspnea, wound, UTI, Foley catheter, smoking cessation and anxiety. Also in (RR#10) there were no outcome measures to manage severe pain, a chest tube, tracheostomy, and a large mass on the neck. Also, the care plan did not address the communication needs of this patient who could not speak. This was confirmed with the administrator. no goals identified to address communication (unable to speak), nausea and vomiting

Observed in Record Review. In 2 of 2 recertification records reviewed, The hospice nurse surveyor noted (RR#7) that the most recent recertification plan of care was not updated to reflect the new needs of the patient including, joint pain, +3 pitting edema, pruritic and dizziness. The plan did not include any outcome measures or time frames to address the new needs or to update previously noted symptoms of pain, constipation and dyspnea. Also, in (RR#9) there were no care plan updates to address recent symptoms of pruritic and delusions and grief due to the recent death of the patient's brother. Also, none of the previously listed goals include outcome measures or time frames. This was confirmed with the administrator.

Observed in Emergency Management Session. In 1 of 3 years, The hospice nurse surveyor noted that the organization failed to conduct and evaluation of their 2021 drill and identify deficiencies and opportunities for improvement. This was confirmed with the administrator.

Observed in Individual Tracer. The hospice nurse surveyor noted (HV#2) that he initial assessment indicated that the patient had constipation; however, there was no evidence that the severity of the symptoms and the factors that alleviate or exacerbate physical symptoms were assessed. This was confirmed with the administrator.

Observed in Individual Tracer. In 2 of 11 patient records reviewed, The hospice nurse surveyor noted (HV#1) that the initial bereavement risk assessment was not completed as required within the first five days, or since. Also, in (HV#2), the surveyor noted that the patient's caregiver had experienced the loss of her son and brother-in-law a few weeks after the patient was admitted; however, there was no indication that the bereavement risk was re-evaluated. This was confirmed with the administrator.

Observed in Individual Tracer. In 1 of 11 patient records reviewed, The hospice nurse surveyor noted (HV#2) that the visit notes indicated that the patient was smoking in bed; however the issue was not addressed on the care plan and there was no indication that any interventions were updated to address the safety of the patient when smoking. The surveyor noted in discussion with the social worker, that the patient was switched to e-cigarettes, but this was not indicated in the interdisciplinary team updates. This was confirmed with the administrator.

Observed in Individual Tracer. In 2 of 11 patient records reviewed, The hospice nurse surveyor noted (HV#1)that there was no evidence in the Interdisciplinary Team meeting minutes or the patient's plan of care to reflect progress toward goals. For example, the patient was admitted with dyspnea and constipation in 2020; however there was no indication that the dyspnea or constipation were managed or that the symptoms improved or declined. Also, the surveyor noted (HV#2) that the chaplain, social services and nursing notes indicated that the patient's son and brother had passed away, since the patient was admitted; however, the plan of care was not updated to include managing the patient and caregivers recent loss and grief response. This is a repeat finding. This was confirmed with the administrator.

Observed in Individual Tracer. The hospice nurse surveyor noted (HV#3) that a nurse visit note indicated that the nurse administered Morphine 0.5 ml. orally. The surveyor noted that the order was a range of 0.25 ml to 0.5 ml and did not include instructions for administering the higher dose of range, as the first dose. The policy stated the ranges be defined for dosing based on symptoms ; however, this was not clarified before the medication was administered. Also, in (ARR#1) on the initial assessment visit the nurse administered the higher dose of Morphine before clarifying the range order instructions for Morphine 0.25 ml -0.5 ml. This was confirmed with the administrator. The surveyor confirmed that the organization did not have a guideline or procedure for dosing medications contained in the comfort kit.

Observed in Data Tracer. In 3 of 3 years, The hospice nurse surveyor noted that the organizational performance improvement program di not reflect the complexity of the organization and its services. The surveyor noted that there was no evidence that they had evaluated their contracted services or bereavement program. Also, the surveyor noted that the QAPI program did not focus on indicators that were related to improved palliative outcomes. The only project was related to documentation of prn medications and not patient care outcomes. This was confirmed with the administrator.

Observed in Data Session. In 3 of 3 years, The hospice nurse surveyor noted that the organization failed to identify opportunities for improvement. The surveyor noted that the organization was collecting data; however, there was no evidence that they had used the data or external data to identify improvement opportunities. For example, the organization was collecting data on falls with injury; however there was no evidence of an analysis of the cause, frequency or contributing factors in order to prevent future falls. This was confirmed with the administrator.

Observed in Data Session. In 3 of 3 years, The governing body/leadership did not ensure that the following Conditions of Participation were met as determined through observations, documentation, and staff interviews: §418.100, 418.56 and 418.58.