Failure to Coordinate Hospice Services
Penalty
Summary
The facility failed to obtain a diagnosis and order for hospice services and to ensure the coordination of hospice services with facility services for a resident requiring end-of-life care. The facility's policy indicated that hospice services should be provided through collaboration with a Medicare-certified hospice agency when ordered by the resident's physician. However, the clinical record of a resident admitted to the facility showed a physician order to admit to hospice but lacked a diagnosis related to the need for hospice services or an order to admit the resident to hospice services. The resident's comprehensive care plan did not display the coordination of hospice services, as it failed to include contact information for the hospice agency and instructions on accessing the hospice's 24-hour on-call system. This lack of coordination was confirmed during an interview with the Registered Nurse Assessment Coordinator, who acknowledged the facility's failure to ensure the coordination of hospice services with facility services to meet the resident's end-of-life care needs. Additionally, a review of the resident's hospice communication binder revealed a hospice admission order form that was not signed by a physician, which is a requirement under Medicare regulations. The Nursing Home Administrator and Director of Nursing confirmed the facility's failure to obtain a diagnosis and order for hospice services and to ensure the coordination of hospice services with facility services for the resident.
Plan Of Correction
Resident #46 orders were updated immediately upon discovery during survey. Hospice contact information was obtained and updated in the hospice communication binder located at the central nurse's station. Moving forward, the facility will ensure that diagnosis and order for hospice services are obtained and signed by an ordering physician in accordance with Hospice Care Policy and coordination of hospice services. To identify other like residents, the DON/designee will audit current residents on hospice care services to ensure signed physician orders in accordance with Hospice Care Policy and contact information for hospice services. To prevent this from happening again, the DON/designee educated licensed nurses and MDS on the appropriate documentation of resident order diagnosis, order for hospice services are obtained and signed by an ordering physician in accordance with Hospice Care Policy and ensuring coordination of hospice services with facility services to meet the needs of the resident. To monitor and maintain ongoing compliance, the DON/designee will audit residents on hospice services weekly x4 then monthly x2 to ensure diagnosis order for hospice services, signed physician order, and contact information for hospice services documented in the medical record. Negative findings will be corrected. Ad Hoc education will be provided as needed. The results of the audits will be forwarded to the facility Quality Assurance Performance Improvement (QAPI) committee for further review and recommendations.