Every finding on record at Traditions Hospice of Lafayette, LLC

Observed in Record Review. In 10 of 14 active patient records reivewed, where the interdisciplinary group met more than two times, updates to comprehensive assessments did not include information about patients’ progress toward desired outcomes. Interdisciplinary meeting notes did not consistently document progress, and plans for care in records RRHV#1, RRHV#2, RRHV#4, RRNHV#1, RRNHV#2 RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#7, and RRNHV#9. Documentation omissions included: progression in funeral planning; family concerns for transitioning patient; caregiver Hoyer lift education; caregiver psychosocial concerns in caring for estranged mother; volunteer service needs; minimizing falls; reducing need for high flow oxygen; inadequate nutrition with intake of fluids only; fear and anxiety related to how death would occur; and need for urinary catheter changes. This RFI was reviewed with the Director of Hospice Operations, Regional and Branch Administrators.

Observed in Record Review. In 14 of 14 active patient records reviewed, goals were specific, but did not include metrics to determine progress, and most were to be met by the time of death or discharge. For example, patient or caregiver will: Have safety needs met by the time of death or discharge; verbalize/demonstrate reduction or relief of cardiopulmonary symptoms by time of death or discharge; verbalize/demonstrate understanding of how to use oxygen safely and effectively by time of death or discharge; will follow an effective bowel program to prevent/relieve constipation by time of death or discharge; verbalize/demonstrate understanding of management of diabetes to prevent a diabetic event by time of death or discharge; will verbalize knowledge of preventative measure/response in the event of hemorrhage; patient/caregiver will have has decreased anxiety/fear regarding the death and dying process. This RFI was reviewed with the Director of Hospice Operations, Regional and Branch Administrators.

Observed in Tracer Activities. In 2 of 14 active patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. An order written only as “volunteer requested” in record RRNHV#7 did not address the scope and frequency of the services to be provided. This RFI was reviewed with Regional and Branch Administrators.

Observed in Record Review. In 2 of 14 active patient records reviewed, the hospice did not ensure that the plan of care included all services needed for the palliation and management of the terminal illness and related conditions. In the initial comprehensive assessment of record RRNHV#2 completed more than three months prior to this survey, a registered nurse noted that the patient had an oxygen concentrator and tank in his home. However, the plan of care did not specify liter flow rate, delivery device, or if it was to be used as needed or continuously. This RFI was reviewed with Regional and Branch Administrators.

Observed in Patient Home. In 2 of 4 home visits conducted, the hospice did not implement infection prevention activities. For example, at RRHV#1 and RRHV#2 a registered nurse cleaned her equipment with Microkill bleach wipes by wiping each item and placing it on a barrier to dry but did not follow the manufacturer’s instructions for use requiring two minutes dwell time for low level disinfection. This RFI was reviewed with Regional and Branch Administrators.