Every finding on record at Traditions Hospice of Longview, LLC

Observed in Tracer Activities. In 3 of 8 patient records reviewed, it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#2 the patient had two medications (Milk of Magnesia and Sena) on her medication profile for constipation, however, there were no instructions of when to give which medication. Additionally, the patient had liquid morphine ordered for PRN pain, however there were no parameters for what type/level of pain. For RRNHV#2, there were no indications for PRN Tylenol. For NHV#3 there were two medications for constipation (Bisacodyl suppositories and MiraLAX), however there were no instructions on when to give which medication. Findings were verified by the Branch Director and Regional Director.

Observed in Record Review. In 6 of 6 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For RRHV#1, the patient was bedbound with varying degrees of paralysis related to his terminal illness, this was not mentioned in the aide care plan. RRHV#2, RRHV#3, RRNHV#1, the hospice aide was to weigh the patient, however there were no parameters for when to call the nurse. Additionally, there were no instructions to notify the skilled nurse related to skin breakdown or any change in condition in RRHV#1, RRHV#2, RRHV#3, RRNHV#1, RRNHV#3, and RRNHV#5. Findings were discussed and verified by the Branch Director and the Regional Director.

Observed in Record Review. While reviewing the record for RR#2 the surveyor found that not all disciplines completed the comprehensive assessment within five days of the patient electing the hospice benefit. This was reviewed with the Administrator.

Observed in Record Review. In 5 of 11 patient records reviewed, where the interdisciplinary group had met more than twice, the organization did not update comprehensive assessments to reflect changes that had occurred since the initial assessment. The surveyor found that notes did not document on-going patient decline, progress toward goals, and plans for the next two weeks. This was reviewed with the Administrator.

Observed in Record Review. In 5 of 11 patient records reviewed, the hospice did not develop plans of care that were based on the patient’s goals and the time frames, settings, and services required to meet those goals. For example, most goals were not measurable. As well, time frames were missing, or noted to be at “the end of cert period.” This was confirmed by the Administrator.

Observed in Record Review. In 5 of 11 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. In most of the records reviewed, interventions and goals related to falls were not addressed in the plan of care, despite patients having been identified as high risk for falls using the MAHC-10 scale. This was reviewed with the Administrator.

Observed in Record Review. In the record of RR#6 the surveyor found in several notes that the patient was using oxygen by nasal cannula, however, there was no order. This was confirmed by the Administrator.