Craven County Hospice

“Based on agency policy, record review, and staff interviews, the plan of care failed to include wound care orders for 1 of 3 patients with wounds (patient #3); and for tracheostomy care for 1 of 1 patient with a tracheostomy (artificial airway) (patient #8) in the plan of care. Finding included: A policy The Plan of Care (revised 02/2015) received on 10/07/2024 at approximately 12:00 PM from the agency director stated, “;The written plan of care will contain... Drugs and treatments. Physician (or other authorized licensed independent practitioner) orders.” Patient #3, a facility resident, was admitted on 04/06/2024 with a diagnosis of Alzheimers disease. The plan of care for 07/05/24-10/02/24 included orders for skilled nurse (SN) visits 1 time a week for 12 weeks and 14 PRN (as needed). Review of the clinical record revealed registered nurse (RN) #10 documented the following information on 07/30/24, “;Skin integrity: Wounds/Lesions/Decubiti [pressure ulcer] assessed.” Review of the plan of care revealed no order for wound care. RN #10 was not available for an interview. Patient #8 was admitted on 09/14/24 with a diagnoses of malignant neoplasm of larynx (cancer of the area of the throat used for breathing, swallowing, and talking) and encounter for attention to tracheostomy.” During the registered nurse (RN) visit of 09/14/24 RN #3 stated, “;Tracheostomy in place. CG [care giver] is performing trach care/change inner canula daily.” Review of the plan of care revealed no order for tracheostomy care. An interview conducted on 10/08/24 at approximately 4:00 PM with the clinical manager RN#3 revealed that the agency does not include orders for treatments in the plans of care that the caregiver, families, or facility staff are completing.”

“Based on direct observation, job description review, aide training handout review, agency policy review, clinical record review, and staff interview, the hospice aide failed to observe standard safety practices while providing care and performed tasks that were not on the aide care plan and for 1 of 1 observed aide visit (Patient #11). Findings included: 1. An aide education handout titled “;Assisting with ADLs [activities of daily living]” was received from the clinical manager on 10/09/24 at approximately 11:25 AM. This policy revealed, “;Assisting with mobility and bathing requires detailed attention to safety due to the risk of falls or injury...” A policy titled “;Hospice Aide Training” and revised 04/13 was received from the clinical manager on 10/09/24 at 11:37 AM. This policy revealed, “;The competency evaluation program will be conducted annually and will include observation of performance of the following skills...appropriate and safe techniques in personal hygiene and grooming...” Patient #11 was admitted to the agency 06/21/24 with a primary hospice diagnosis of prostate cancer. The Plan of Care (POC) from 09/19/24 to 12/17/24 revealed orders for skilled nursing one time per week for 13 weeks, medical social worker one time per month, hospice aide one time per week for 13 weeks, and respite aide one time per week for 13 weeks. On 10/08/24 at approximately 10:30 AM, Employee #7, hospice aide, conducted a home visit for Patient #11 which was observed. Employee #7 was observed leaving the room to obtain clean water while the patient was positioned to the right side of the bed, the right side rail was down, and the bed was in high position. While Employee #7 was out of the room, the patient was observed moving in bed as if he planned to get up. In an interview on 10/09/24 at approximately 10:15 AM, Employee #7 acknowledged that lowering the bed and putting the side rail up was “;overlooked” and should have been done prior to leaving the room. In an interview on 10/09/24 at approximately 10:20 AM, Employee #3, clinical manager, stated that the expectation would be “;...the bed is lowered, and the bed rail is up...” and “;That is a safety issue.” 2. The Hospice II Position Description Form revised 09/24, was received from the agency director on 10/09/24 at 9:00 AM. This policy revealed, “;A written plan of care on each patient outlines specific procedures and activities to be performed. Special instructions are given for special tasks.” On 10/08/24 at approximately 10:30 AM, Employee #7, hospice aide, conducted a home visit in which she was observed applying barrier cream to the patients coccyx (tailbone) area and a roll-on topical analgesic (pain medication) to the patient’s left shoulder. In an interview on 10/09/24 at 10:15 AM, Employee #7 stated that instructions to reinforce the patients coccyx wound dressing was previously on the aide care plan but she did not know if the barrier cream was on the current aide care plan. Employee 7 stated, “;I dont make the care plan, so I dont know [if the barrier cream or topical analgesic application is on the care plan] ...He said his shoulder was hurting... He made the complaint about his joint hurting, and I put his [brand name of topical analgesic] on...” In an interview on 10/09/24 at approximately 10:20 AM, Employee #3, clinical manager, stated, “;Everything... should be on the med [medication] list because it [barrier cream and topical analgesic] is a topical medication and it should be on the aide care plan to use.””