Hospice of Northwest Ohio

“Observed in Individual Tracer. In 5 of 20 patient records reviewed, the assessments were not complete. The section of the nursing assessment for psychosocial assessment was left blank in RR#4. The Policy titled Treatment and Services reflected that the Comprehensive Nursing assessment should include this assessment. Additionally, there was no documentation in the records of inpatient #2 , RR#7 , RR#6 of the need for volunteer services. RR#5 had a stage 4 decubiti and there was no further description of the wound. This observation was discussed with the VP of Compliance.”

“Observed in Record Review. In 3 out of 20 records, the care plan lacked measurable psychosocial goals. Examples: In RRHV#11, the psychosocial goal was the following: stay out of the hospital and be healthy. In RRHV#12, the psychosocial goal was the following: 1. Son wanting his mother to get the best care possible at the assisted living facility. Will be maintained for the next 30 days. 2. Patient will have social well-being maintained over the next 30 days. In RRHV#13, the following psychosocial goals were identified: 1. Emotional pain level to be comfortable and maintained for the next 30 days. 2. CG’s emotional pain level to be comfortable at end of life and maintained for the next 30 days.”

“Observed in Tracer Visit. In 5 of 20 records reviewed, oxygen range orders lacked clearly defined parameters and indications for adjusting or changing the settings. For example, in RRHV#11, RRHV#18, and RRHV#20, oxygen was ordered at a range of 2–4 liters per minute as needed; however, no guidance was provided for titration or adjustment. Similarly, in RRHV#14, oxygen was ordered at a range of 2–10 liters per minute without any specified parameters for adjustment. In RRHV#17, oxygen was ordered at a range of 2-9 liters per minute without any specified parameters for adjustment. These findings were confirmed by the VP of Clinical Services. Observed in Individual Tracer. In 3 of 20 patient records reviewed, the comprehensive care plan did not include required safety precautions based on the assessments. The section of the care plan for safety was left blank for RR#3, RR#4 did not include oxygen or aspiration precautions, and RR#7 had a history of dysphagia and aspiration precautions were not included on the care plan. This observation was discussed with the VP of Compliance. Observed in Tracer Visit. In 2 of 20 records reviewed, the plan of care did not incorporate the patient’s mental status, despite comprehensive assessments indicating that it impacted the level of care required.Examples: In RRHV#12 and RRHV#13, the mental status section of the plans of care was left blank. However in RRHV#12, the comprehensive assessments indicated the patient was oriented only to self and unable to follow commands. In RRHV#13, comprehensive assessments documented that the patient was alert only to person, forgetful, and confused. This was confirmed by the VP of Clinical Services. Observed in Tracer Visit. In 1 of 20 records, the plan of care did not include functional limitations reflected in the identified needs within comprehensive assessments. Example; In RRHV#12, recertification assessments for benefit period 20 identified functional limitations as non-ambulatory, transfers only with a Hoyer lift to chair, contractures, and dependency with all ADLS. However, these assessment findings were not included within the blank functional limitation section of the plan of care. This was verified by the VP of Quality and Compliance. Observed in Tracer Visit. In 3 out of 20 records, the plan of care did not include all safety risk identified within comprehensive assessments. Example: In RRHV#11, RRHV#12, and RRHV#14, patients scored at risk for falls within their fall assessments. However, falls safety measures were not included in the current plans of care. In RRHV#12 and RRHV#14, patients were on oxygen as needed. However, oxygen precautions were not listed on the plans of care. This was confirmed by the VP of Quality & Compliance. Observed in Record Review. In 1 of 20 records reviewed, the organization failed to obtain complete physician orders in accordance with professional standards of practice. Example: In RRHV#15, the plan of care orders for the indwelling catheter did not specify the frequency for catheter changes. Additionally, in RRHV#15, the wound care orders for the patient’s left heel (performed by facility staff) did not detail the specific care to be provided. The wound care orders were documented as: “Wound care per facility as per orders.” These findings were confirmed by the Informatics Nurse.”

“Observed in Tracer Visit. During 1 of 6 home visits, the hospice failed to adhere to accepted standards of practice for preventing the transmission of infections and communicable diseases. For example, during RRHV#13, the nurse was observed not changing gloves or performing hand hygiene after cleaning the wound bed and assessing for tunneling of a stage 3 pressure ulcer on the right lower extremity prior to applying a new dressing. In addition, on this same visit, the nurse did not change gloves or perform hand hygiene after providing wound care to the stage 3 pressure ulcer before conducting a physical assessment of a wound on the third digit of the patient’s left foot. This was confirmed by the VP of Clinical Services.”