Traditions Health

“Observed in Record Review. In 2 of 10 patient records reviewed, for active patients, it was noted by the nurse surveyor that the bereavement risk assessment was not completed as part of the comprehensive assessment. For RRHV#3, the Bereavement Risk Assessment was completed two months after the patient was admitted. For RRNHV#5 there was no documented Bereavement Risk Assessment by any member of the Interdisciplinary Team as required since admission three months ago.. Findings were discussed and verified with the RN Branch Manager, VP of Quality and Standards, and Regional Clinical Director.”

“Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that orders were not clear or complete. For RRHV#2 the patient had Metoprolol on his medication profile, however, the patient did not have any in the home. It was unclear at the time of the visit if the patient was to be taking the medication or not. The patient was also taking Tamsulosin 0.4mg, the EMR medication profile instructions said take 2 tabs po every night, the bottle said to take one table twice a day. The patient’s wife said he was taking it twice a day. Additionally, the patient’s EMR stated he had Ativan 1mg tab ordered PRN anxiety. there was no time frame between doses or maximum dose noted. Also the patient only had liquid Ativan in the home, 2mg/ml, 1/2ml was to be given (1mg) every four hours PRN anxiety. He was also getting a Dobutamine Drip, the instructions were to inject 332 mcgg/min into the vein continuously for 5 days, the five days were up and he was still receiving the medication and there were no instructions for pump settings in the order/instructions. Findings were verified by the Branch Director who was present on the visit.”

“Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow infection control practices and agency policy when performing patient care. During RRHV#2, During the home visit, the RN placed used equipment (blood pressure cuff and stethoscope) back onto the barrier alongside clean items. She completed vital signs, assessed the PICC line dressing, and applied barrier cream to the patient’s buttock—all without changing gloves. Without performing hand hygiene or changing gloves after handling supplies, she opened the PICC line dressing kit and donned sterile gloves over her existing gloves before completing the dressing change. After the procedure and tidying the area, she removed both pairs of gloves and sanitized her hands. Findings were verified by the Branch Director who was present on the visit.”

“Observed in Record Review. In 7 of 7 patient records reviewed, for patients with a hospice aide, it was noted by the nurse surveyor that the hospice aide care plans did not include the information necessary for the hospice aide to effectively care for the patients. For RRHV#2, the patient had a PICC line, chest tube, skin breakdown, and continuous oxygen, yet the hospice aide are plan did not mention or address what the hospice aide’s responsibility should be in response to these. RRHV#3, the hospice aide care plan did not inform the hospice aide that the patient had toe to knee dressings on his legs nor what to do/report if they were soiled or dislodged. Also, the patient had left side hemiplegia with contractures that the hospice aide care plan did not mention. Additionally, for all patients with a Hospice Aide, there also were no instructions to notify the skilled nurse if there was a change in the patient’s condition. Findings were discussed and verified with the RN Branch Manager, VP of Quality and Standards, and Regional Clinical Director.”

“Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that the medication profile was inaccurate. During RRHV#2, it was noted during the medication reconciliation by the skilled nurse, that the patient had been taking Jardiance, Atorvastatin, and Empaghflozoin since admission, however, they had never been added to the patient’s medication profile. Additionally, the patient’s wife was applying Calmoseptine Cream topically to the patient’s raw buttocks area, which had not been added to the medication profile. The patient had been on service over one week. Findings were verified by the Branch Manager who was present during the visit.”