Failure to Coordinate Hospice Services for Residents
Penalty
Summary
The facility failed to obtain a physician order for hospice services and ensure the coordination of hospice services with facility services for three residents. Resident R3, who was admitted with diagnoses including high blood pressure, depression, and dementia, had a physician order indicating hospice services but lacked documentation from the hospice service, including admission details, a plan of care, and communication records. Additionally, the comprehensive care plan for Resident R3 did not include contact information for the hospice agency or instructions on accessing the hospice's 24-hour on-call system. Similarly, Resident R8, diagnosed with high blood pressure, dementia, and Parkinson's disease, had a physician order for hospice services without a related diagnosis. The care plan also failed to include necessary hospice coordination details. Resident R39, with dementia, diabetes mellitus, and hyperlipidemia, had a physician order to consult hospice care but lacked vendor information and a qualifying diagnosis. The Director of Nursing confirmed these deficiencies, which were in violation of several Pennsylvania Code regulations regarding licensee responsibilities, management, staff development, and resident care policies.
Plan Of Correction
The Director of Nursing/designee completed a whole house audit on 1/1/25 of active hospice residents to ensure MD orders were updated and plans include resident diagnoses for hospice and hospice contact information. Each resident has a form of internal communication from the assigned hospice. R3, R8, and R39 were not affected by the deficient practice of not having all the required documentation of hospice services on resident charts. The Director of Nursing/Designee will educate team members on the required documentation for the clinical record for resident hospice services admission. Each hospice resident has an internal communication process from the assigned hospice. The DON/designee will conduct weekly audits for 4 weeks of hospice residents to ensure they have a hospice order, diagnosis for hospice, and contact information for the resident's selected hospice service. The Director of Nursing/designee(s) will audit for four weeks the communication books for each hospice resident to ensure the internal communication process is in place for residents served by the identified hospice. The results of audits will be submitted to the QAPI committee to review for any trends for which further improvement plans may need to be considered.