Failure to Obtain Hospice Diagnosis
Penalty
Summary
The facility failed to obtain a diagnosis for hospice services for one of its residents, identified as Resident R32. The resident was admitted to the facility on January 7, 2025, and had a Minimum Data Set (MDS) assessment dated January 14, 2025, which indicated diagnoses of high blood pressure, hyponatremia, and respiratory failure. Despite these documented conditions, the facility did not secure a specific diagnosis related to the need for hospice services. A physician order dated January 22, 2025, instructed the admission of Resident R32 to hospice care. However, this order did not include a diagnosis that justified the need for hospice services. Similarly, the resident's care plan, also dated January 22, 2025, noted that the resident had a terminal prognosis and was receiving hospice care, but it failed to specify a diagnosis related to the hospice services requirement. During an interview on January 20, 2025, the Director of Nursing confirmed the facility's failure to obtain the necessary diagnosis for hospice services as required. This deficiency was identified based on a review of the facility's policy, resident clinical records, and staff interviews, highlighting a lapse in compliance with the regulatory requirements for hospice care coordination.
Plan Of Correction
Resident R32 diagnosis added for hospice care. All residents with hospice have been checked to ensure there is an admission diagnosis ordered with the start of hospice care. For all admissions to hospice, a diagnosis will be obtained from hospice and noted with the hospice order to admit to hospice, that clarifies why someone was admitted to hospice. The Director of nursing or designee will educate all the nursing staff that a diagnosis is needed in order for someone to be admitted to hospice and to verify the diagnosis is with the order for hospice services. The Director of Nursing or designee will initiate a QAPI to check that every new hospice admission has a diagnosis for admission to hospice. QAPI will be completed every week for 1 month, bi-weekly for one month and monthly thereafter. All results will be reviewed with the QA committee.