Hospice of North Central Oklahoma, Inc.

“Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that the nurse conducted a medication assessment but failed to observe all of the patient’s medication. For HOSRRNHV#1, the skilled nurse asked the Assisted Living Facility’s Medication Aide for a copy of the patient’s current medication list that she used to compare with the medication list in the Hospice’s MAR, she then asked what the count was of each of the patient’s narcotics. The Medication Aide looked in their narcotic book and read off the count of each of the narcotics. The nurse did not initially look at the medication cards themselves until prompted. The skilled nurse stated she never looked at the actual medications, she only compared the two lists and asked for the narcotic count. Findings were discussed and verified with the Chief Operating Officer who was present on the visit.”

“Observed in Record Review. In 3 of 14 patient records reviewed, it was noted by the nurse surveyor that orders were unclear. For HOSRRHV#1, Oxygen orders were for 2 -5 liters per minute BNC to relieve shortness of breath. The order did not state if it was to be continuous or PRN nor did it include parameters of when to increase the oxygen flow. For HOSRRHV#2, there were multiple PRN medication orders for constipation, Dulcolax tablets, Dulcolax Suppositories, Colace, MiraLAX and Lactulose the order did not contain information regarding which medication to take first. HOSRRHV#3, Oxygen orders were for 2 -5 liters per minute BNC to relieve shortness of breath. The order did not state if it was to be continuous or PRN nor did it include parameters of when to increase the oxygen flow, the patient was using it only at night. Findings were discussed and verified with the Chief Operating Officer who was present on the visit.”

“Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that the staff failed to follow acceptable practice and agency policy when performing patient care. During HOSRRHV#1, the skilled nurse washed her hands, donned gloves and then proceeded to touch items in the patient’s room including the patient and went in and out of her nursing bag. After assessing the patient, she removed the patient’s dressing from a back wound, then changed her gloves. She then went into her nursing bag, obtained the new dressing, took the medication to be applied to the wound out of the box and redressed the wound. Additionally, after cleaning her equipment, she put the clean equipment back on the barrier in the same place the dirty equipment had been and did not allow for a minute dry time as required by the sanitizing wipes used. Findings were verified by the Chief Compliance Officer who was present on the visit.”

“Observed in Record Review. In 3 of 12 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 HOSRRHV#1, the patient was on continuous oxygen and there were no instructions as to what to do with the oxygen during the patient’s bed bath. Additionally, there were no instructions regarding what the hospice aide’s responsibility was regarding the wound dressing on the patient’s back or the yeast infection under her breasts. For HOSRRHV#2, the patient was on continuous oxygen and there were no instructions as to what to do with the oxygen during the patient’s bed bath. For HOSRRHV#3, the care plan instructed the hospice aide to give the patient a shower, however the instructions did not include the details of how to complete the task which required special instructions since the bathroom did not contain a conventional shower. Findings were discussed and verified with the Chief Operating Officer who was present on the visit.”

“Observed in Patient Home. In 1 of 4 home visits conducted, it was noted by the nurse surveyor that for HOSRRHV#2 there were four large backup oxygen tanks and one smaller one stored in a stand in the garage less than five feet away from the daughter’s SUV. Additionally, there were two large back up oxygen tanks in the back of the daughter’s SUV. She kept them in the car for when she took her father (the patient) out. The current temperature in the location of the survey was hitting triple digits with the heat index, the garage with the doors shut had questionable ventilation. The daughter stated she did not remember anyone telling her not to keep the tanks in the garage or car. All the tanks were immediately brought into the house by the daughter and the Chief Operating Officer who was present on the home visit.”