| 40 |
KULA HOSPITAL |
125003 |
100 KEOKEA PLACE |
KULA |
HI |
96790 |
2018-06-22 |
849 |
D |
0 |
1 |
GCA011 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility and the hospice did not collaborate in the development of a coordinated plan of care for 1 of 3 residents (R179) receiving hospice services. Findings Include: On 06/20/18 at 08:17 AM, R179 was heard yelling from her room. Staff 6 (S6) stated R179 was a hospice resident. S6 said when staff attends to her yelling, she tells them that she didn't know she was yelling. Surveyor went to R179's bedside and asked her if she was in pain. R179 replied, Yes, all over. A staff came into R179's room to get towels from the closet and stated she would attend to R179 after finishing up with another resident. S6 came to assess R179's pain and informed S22. After adjusting R179's position and pillows, S22 asked resident what type of pain meds she preferred, either [MEDICATION NAME] or Tylenol. R179 stated, Do I have a choice? When queried later, S22 stated that R179 used to be able to say what type of pain she had (e.g., pain level of 9-10), but from yesterday, she was unable to. S22 said, [MEDICATION NAME] is prn every 4 hrs and last dosage given last night at 20:15 (8:15 PM). S22 stated she just gave R179 [MEDICATION NAME] because, Resident was crying so probably severe pain. After receiving the pain meds, R179 was provided breakfast and observed that resident ate without pain and a CNA assisted her. On 06/20/18 at 08:38 AM, interviewed S6. He stated that R179 will be discharged from hospice because the resident was admitted as hospice but as full code and that it did not make sense to him. S6 talked to the hospice provider and was told the hospice provider got into trouble for not accepting residents who were full code and R179 was placed into hospice care at the hospital she was transferred from. The [DIAGNOSES REDACTED]. The hospice benefit period was 06/08/2018 - 09/05/2018. The hospice physician's signature on 06/08/18 also included information of the resident's code status (attempt resuscitation); diet as tolerated; activity as tolerated; and oxygen 2-5L via NC/Mask for dyspnea/comfort PRN. On 06/20/18 at 09:26 AM, interviewed S20. She stated the hospice nurse came twice a week and the hospice CNA three times a week. There was no set schedule for the hospice nurse but she came in to address R179's change in mental status. R179 became delusional, confused with increased yelling, so S20 suggested it was over medication with benzodiazepine which the hospice nurse agreed with on 06/17/18. The benzodiazepine was discontinued on that date and the telephone order read back (TORB) was done with the hospice physician. On 06/21/18 at 10:33 AM, review of the facility's baseline care plans (CP) for R179 was done. The activities assessment, under Emotional Mood/Behavioral Status, per (friend/therapist), noted R179 had history of delusions while hospitalized . There was no family on the island and R179's former therapist assisted the resident with her current situation. The baseline CP included intervention/approaches for, Staff to administer medications (meds) as ordered and observe for effectiveness and side effects. The medications ordered for R179 included meds for depression, diabetes, [MEDICAL CONDITION], and low [MEDICAL CONDITION] function. The meds ordered as needed (PRN), included [MEDICATION NAME] for pain, Tylenol suppository for pain/fever, [MEDICATION NAME] for pain/fever, and [MEDICATION NAME] for pain/shortness of breath. The hospice CP with start date 06/08/18 and last updated on 06/18/2018 for problem of physical comfort alteration secondary to [DIAGNOSES REDACTED]. /stress level. Notify MD if necessary. On 06/22/18 at 08:28 AM, surveyor interviewed the hospice nurse. She stated the hospice director developed the CPs for R179 and the hospice nurse will add to it if something came up. The meds were the previously established hospice meds which the hospice MD would adjust as needed. The CPs were faxed over at admission and the hospice nurse does a 24 hour follow-up to ensure CPs are appropriate. There were no changes to R179's CP at the 24 hr follow-up. Queried the hospice nurse about the pain meds and when facility staff should use [MEDICATION NAME] sulfate (MS) versus [MEDICATION NAME]. She stated that PRN MS was a standard pain med for hospice and should be specified in the order. Review of the admission physician orders [REDACTED]. On 06/22/18 at 09:23 AM, S22 said she was on vacation when R179 was admitted . Queried S22 what pain meds she would give R179 for pain, and S22 stated she would ask resident her preference. When S22 returned from vacation, she didn't have time to look at R179's CP and just asked resident her preference and she wanted [MEDICATION NAME]. On 06/22/18 at 09:26 AM, interviewed S20 and she stated that after R179 was admitted on [DATE], the hospice physician came once on 06/11/18. S20 stated the hospice admission process was confusing because the facility never admitted a hospice resident before. S20 said usually the resident was already in the facility and switched to hospice status. S20 wasn't sure if she should call the family/representative for changes in R179's condition or call the hospice nurse, stating she didn't want to duplicate calls to the family/representative. On 06/22/18 at 09:41 AM, interviewed the hospice CN[NAME] She said she gave R179 a bath on Mondays, Wednesdays, and Fridays at 10:00 AM. Queried the CNA if there was a CP developed by hospice for her to follow. There was no CP found for this. The long term care staff was unaware of the hospice staff's schedules, whether R179 was an appropriate hospice admission, whether the type of pain meds given to R179 achieved pain relief as her different pain meds had similar parameters to follow, and, the facility staff was not familiar with the roles of the hospice staff nor followed a coordinated CP delineating each care and service the hospice was to provide for R179. |
2020-09-01 |