Failure to Coordinate Hospice Care and Monitor Bruising in Residents
Penalty
Summary
The facility failed to coordinate care with an outside hospice agency for a resident receiving end-of-life services. The resident had significant cognitive impairment, including memory loss, hallucinations, and rejection of care behaviors, and was identified as being at the end stage of life. The care plan indicated the use of hospice services but lacked specific details about the frequency and nature of hospice visits and interventions. The hospice binder at the nursing station contained incomplete and outdated information, including missing calendars for upcoming visits and insufficient documentation of the services provided. Staff interviews revealed uncertainty about when hospice staff would visit, lack of communication regarding medication renewals, and an absence of a readily available hospice care plan for facility staff. Both facility and hospice staff acknowledged the lack of a set schedule and the need for better communication and documentation. Additionally, the facility failed to assess and appropriately monitor developing bruising for a resident on anticoagulant therapy. The resident had multiple medical conditions, including peripheral vascular disease, dementia, and a history of hip fracture, and required significant assistance with activities of daily living. The care plan addressed anticoagulant use and skin integrity but did not include specific interventions to prevent bruising. Observations showed the resident had visible bruising and a scab with drainage on the hands, but documentation in the electronic health record and risk management system lacked consistent assessment and follow-up on the bruising. Staff interviews indicated that bruises were addressed on a case-by-case basis, and there was no clear documentation or monitoring process in place for the resident's bruising. Facility policies required coordination with hospice providers and monitoring for complications in residents on anticoagulants, but these were not fully implemented. The lack of clear communication, documentation, and follow-up contributed to the deficiencies in care coordination with hospice and in the assessment and monitoring of bruising for residents at risk.