Henry County Medical Center Hospice

“Observed in Record Review. In 3 of 4 patient records reviewed, for active patient, it was noted by the nurse surveyor that the hospice aide care plans did not contain all the necessary information. In HosRRDC#1 the Aide plan of care as incomplete as it only addressed bath without a specific type, foot care, skin care and assist with transfers. Other services were being provide such as shampoo, dressing and nail care but were not address on the plan of care. For HosRRNHV#2 the patient was on Xarelto but no bleeding precautions on the aide plan of care. Further, on the current plan of care the interventions were found to not populate. For HosRRNHV#3 the patient was on oxygen, however, the care plans did not address what the aide should do regarding the oxygen while performing the patient’s activities of daily living. Additionally, the bath stated bath and did not specify the type and the patient was receiving linen change, dressing and positioning that was not addressed. These observations were discussed with the Hospice Supervisor.”

“Observed in Tracer Activities. It was noted by the nurse surveyor during the Leadership Session and review of documents that the organization did not compile and analyze data to identify improvement opportunities. It was noted the organization was reporting and collecting data on patient falls, medication errors/adverse events, and infections as part of the Quality Assurance Performance Improvement Program. There was, however, no documentation to support that data was being compiled and analyzed to identify opportunities for improvement. Finding was reviewed and discussed with the Director of Home Health and Hospice and the Hospice Coordinator.”

“Observed in Patient Home. In 3 of 3 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per “Hand Hygiene Policy”. For example, during RRHV#1 the chaplain performed hand hygiene in the driveway before entering the patient’s home. He then opened the door and entered the home, touched the patient’s hands frequently during the visit, read his bible, then took out his computer to document, all without hand sanitizing. During RRHV#2 with a skilled nurse, she went back and forth from the patient to her tablet to document without performing hand hygiene. During RRHV#3, the hospice aide hand sanitized, then donned gloves. She then gathered the patient’s bathing supplies and clean clothes, filled the wash basins, then proceeded to bathe the patient head to toe, to include his dirty bottom all with the same pair of gloves on. Additionally, she did not change the bath or rinse water after bathing his feet or dirty bottom and then went on to bathe his back. Findings were discussed with the Hospice Supervisor. Observed in Patient Home. In 2 of 3 home visits conducted, it was observed by the nurse surveyor that clinical staff did not clean their equipment per agency policy, “Bag Technique Policy#9-014.1”. For RRHV#2 and for RRHV#3, the nurse and the hospice aide, both cleaned their equipment (BP cuff, stethoscope, thermometer, pulse oximeter) with Sani wipes. The policy states that equipment is to be cleaned with alcohol. Finding was discussed with the Director of Home Health and Hospice and the Hospice Supervisor.”

“Observed in Record Review. In 5 of 10 patient records reviewed, for active patient, it was noted by the nurse surveyor that the hospice aide care plans did not contain all the necessary information. For RRHV#1, RRHV#3, RRNHV#1, and RRNHV#3 the patients were all on oxygen, however, the care plans did not address what the aide should do regarding the oxygen while performing the patient’s activities of daily living. Additionally, there were no instructions regarding when the aide should notify the nurse on any of the hospice aide care plans to include RRNHV#7. Findings were discussed with the Hospice Supervisor.”

“Observed in Patient Home. In 3 of 3 home visits conducted, it was noted by the nurse surveyor that the Admission Booklet for Hospice patients that was reviewed in the office contained a “Disaster Planning Form” which was designed to educate the family and assist in developing an individualized disaster plan. However, during RRHV#1, RRHV#2, and RRHV#3, it was noted that the “Disaster Planning Form” had been removed. After discussion with the Director of Home Health and Hospice and the Hospice Supervisor, it was noted that the forms were being filled out by the admission nurse and returned to the office to be put in the EMR. Additionally, for RRHV#1, when asked about an individualized disaster plan, the caregiver daughter stated that she could not remember any education or information provided.
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