Volume 2024 | No. 2
SURVEYOR
HOSPICE
Examples of surveyor findings:
n During the initial compressive assessment, the spiritual care and MSW services identified needs for scheduled visits. There were no problem statements with interventions and goals included in the plan of care. n The plan of care includes orders for the SN to discuss need for adult protective service referral with IDG. The assessments did not identify risk factors to warrant an APS referral. n No evidence of care plan for psych-social or pain noted in chart. n The MSW and chaplain have discipline orders written for PRN only visits. n The medical record contained an order for oxygen with no delivery method and conflicting frequencies stating both “as needed” and “continuous.” n Comprehensive assessment by the RN indicates patient has a poor appetite consuming meals. No evidence of problems, goals, or interventions addressing this on the plan of care. n The medical record contains documentation of a history of seizures. There is no evidence of problems, goals, and interventions on the plan of care for assessment and management of seizures. n Plan of care does not specify catheter size, whether this is to be completed by facility or hospice skilled nurse, additional instruction on replacing or reinserting as needed for occlusion or displacement, etc., or instructions/indications for catheter flushing. n The medication profile contained duplicate orders. n Medication orders for topical cream does not include an application site. n The plan of care indicated “eight-hour pain reliever” without including the name of the medication. n The IDG indicates the patient has an oxygen concentrator and hospital bed. The plan of care does not include the equipment. n During home visit, a wheelchair and nebulizer were observed in the home. These were not included on the plan of care. n All DME used by the patient, whether supplied by the hospice or by the patient, must appear on the plan of care n Plan of care orders are specific as to procedure, frequency, and modality. The plan of care should demonstrate planning instead of reacting to crisis. This is accomplished by: Developing an individualized plan of care that considers the end-of- life goals of the patient and family. Thoroughly addressing goals, preferences, and interventions for all problems identified in assessments. Consistent communication between all members of the IDG and the patient, family, and/or caregiver. Routine chart audits that identify and correct inconsistencies immediately.
HSP5-4B Overview of the requirement:
Hospice services are delivered according to the written plan of care.
Comment on deficiencies:
Closely related to standard HSP5-4A, evidence of compliance is similarly assessed through review of patient records and comparison to plan of care notes. Deficiencies were cited for visit frequencies that did not match the plan of care. Surveyors also noted a trend of telehealth visits without orders.
Frequency of citation:
49%
Examples of surveyor findings:
n The IDG meetings continued to order nursing at a visit frequency of 1x per week. There were no nursing visits documented for several weeks, then visits were made sporadically for the following months. n Orders were written for the social worker to visit twice weekly, but the social worker visited once monthly. n Plan of care has volunteer frequency as four times monthly. No evidence that these visits occurred for one month. n The visit frequency for the spiritual care counselor was 2x/month. The record indicated only one visit, or missed visits, for three consecutive months. n Plan of care included “refer patient to PT,” with no evidence of PT eval conducted. n There is no evidence that the LVN assessed for medication compliance, provided interventions for medication administration, or made contact with the RN case manager. n There is evidence in the patient chart that podiatry was ordered but no evidence that podiatry visit was completed. n Spiritual care visit and MSW visit were both conducted via telephone. No evidence found on plan of care of telephone/virtual visits acceptable or indicated per MD. n The only nursing visit on record for the week was performed as a telehealth visit. The record does not contain orders for telehealth visits. n The patient record includes evidence of volunteer services and visits being received, but there are no frequency orders in the plan of care for volunteers. n The nurse documented a completed wound dressing change and to “see plan of care.” However, there were no wound orders on the plan. n The plan of care contains an order for narcotic count every visit. There is no evidence of a narcotic count being done in the past six weeks of visits. n The RN received an order to obtain lab draws on the patient. There is no evidence that the results were reported back to the ordering physician. n There is an order for SN to take a picture of the patient’s wound each visit. There is no evidence the pictures are being taken at every visit.
Tips for compliance:
achc.org | (855) 937-2242 | 29
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