Every finding on record at Visiting Nurse Association of Saginaw

Upon patient record review, 14 of 19 charts reviewed (Patient #1-#14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient's #1-#14: There was no evidence in patient record that the comprehensive assessment takes into consideration the imminence of death.

Upon patient record review, 14 of 19 record reviewed (Patient #1-#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1-#14: The record indicated multiple medications on the medication profile. There was no evidence in the record of drug side effects and or drug therapy currently associated with laboratory monitoring that was done on admission and consistently with new medication orders. Patient #1: The record indicated on the medication profile acetaminophen 1,000mg po Q8hours prn fever/pain and acetaminophen 650mg po Q4hours prn fever/pain. There was no evidence in the record of maximum allowable dose in 24 hours. COS. In addition: The record indicated on the medication profile morphine10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #2: Upon home visit, the medication profile indicated Albuterol (Ventolin HFA) 108 (90 base) mcg/ACT HFA Inhaler 2 puffs by inhalation every 6 hours as needed for COPD. This medication was not on the facility medication profile. COS. Patient #4: The record indicated on the medication profile Morphine 10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #5: The record indicated on the medication profile Morphine 10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #7: The record indicated on the medication profile Morphine 10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #12: The record indicated in the IDT noted on 01/22/25 the patient was using OTC Bio freeze to his neck. There was no evidence of this medication on the medication profile, In addition, the record indicated on the medication profile hydrocortisone Topical 1 % gel 1 application 3 times daily for itching. There was no amount of medication or a site location as to where the medication should be applied. COS.

Upon patient record review, 4 of 19 records reviewed (Patient #4, #9, #13, #14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4: The record indicated the patients hospice start of care was on 01/02/25. There was no evidence of a bereavement assessment at the time of the survey. COS. Patient #9: The record indicated the patients hospice start of care was on 11/05/24. There was no evidence of a bereavement assessment at the time of the survey. COS. Patient #13: The record indicated the patients hospice start of care was on 12/17/24. There was no evidence of a bereavement assessment at the time of the survey. COS. Patient #14: The record indicated the patients hospice start of care was on 06/26/24. There was no evidence of a bereavement assessment at the time of the survey. COS.

Upon patient record review, 1 of 19 records reviewed (Patient #4) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #4: The record indicated the patient was admitted on 01/02/25 and was a full code. There was no evidence of an individualized written plan of care based on this problem identified in the comprehensive assessment. COS.

Upon patient record review, 6 of 19 records reviewed (Patient #1, #4, #5, #6, #7, #12) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1: The record indicated an order for acetaminophen 1,000mg po Q8hours prn fever/pain and acetaminophen 650mg po Q4hours prn fever/pain. There was no evidence in the record of maximum allowable in 24 hours. COS. In addition: The record indicated an order for morphine10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range. The standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #4: The record indicated an order for morphine10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #5: The record indicated an order for morphine10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #6: The record indicated an MD order on 01/03/25 for a foley catheter: #16-#18 foley catheter with 5-30cc balloon straight drainage prn change catheter monthly or prn may irrigate with 30-60ml normal saline prn. There was no evidence of what type of solution to put in the balloon. COS. Patient #7: The record indicated an order for morphine10mg - 40mg po Q2hours prn dyspnea/pain. There was no evidence the prescriber included direction on a frequency range. There was no evidence the prescriber included direction on a frequency range and the standing orders and or Policy Number: H3.40 Medication Regimen Management does not include direction on a frequency range and or an established procedure to include decision making.  The decision making cannot be left to a non prescriber. Patient #12: The record indicated an order for hydrocortisone Topical 1 % gel 1 application 3 times daily for itching. There was no amount of medication or a site location as to where the medication should be applied. COS.

Upon patient record review, 14 of 19 records reviewed (Patient #1-#14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1-#14: The record indicated the patient was receiving supplies that were necessary for the palliation and management of the terminal illness. None of the supplies such as adult wipes, under pads, briefs, diapers, gloves, toothettes, and/or gloves were documented in the plan of care. All were COS.

Upon client record review, 1 of 19 records reviewed (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The record indicated the IDG did not ensure the intervention written in the plan of care on 5/3/24 which stated the aide supervisory visit will be done Q14 days or less. The aide supervisory visit was missed on 01/22/25.

Upon patient record review 1 of 19 records reviewed (Patient #1) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #1: The record indicated there was an aide supervisory visit due and completed on 01/08/25. There was no evidence of an aide supervisory visit's on 01/09/25 through 01/22/25.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The annual report for 2024 did not meet the 5%, it was currently documented at 3.25%.

Upon patient client record review, 1 of 19 records reviewed (Patient #15) did not evidence that each patient record contains physician orders. Patient #15: The record indicated the patient entered a non contracted facility and was discharged. There was no evidence of a discharge order on the chart prior to the discharge on 07/10/24.

Upon client record review, 1 of 19 records reviewed (Patient #3) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #3: The record indicated the patient had an active wound on his coccyx. There was no evidence listed in the intervention on 4/24/24 as to which nurse (hospice or facility nurse) would measure the wound weekly. COS.

Upon patient record review, 1 of 19 records reviewed (Patient #3) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice's 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient #3: The record indicated the patient was admitted to hospice services on 01/18/24. There was no evidence of certifications and or recertifications on the facility chart at the time of the surveyor's home visit. COS.

Upon patient record review, 3 of 13 (Patient #3, #8, #11) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient #3: Trazadone was transcribed to the medication profile without a route of administration. Patient #8: Oxygen was ordered and listed on the DME profile, but not transcribed to the medication profile. Patient #11: Plavix was transcribed to the medication profile without a route of administration.

Upon patient client record review, 1 of 13 (Patient # 7) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Patient #7: The CTI narrative contained the pronoun "she" three times in the description of a male patient.