Step By Step Riverwalk Hospice

“It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care; ensure continuous assessment of each patient’s and family’s needs; and ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed revealed that the hospice did not ensure that services were consistent with the interdisciplinary plan of care. CLINICAL RECORD 2: Clinical record review lacked evidence of supervision by the registered nurse to ensure that the nursing needs of the patient were met as identified in the patient’s assessments. 10/21/2024 nursing assessment states “SN provided wound care to the sacrum, medication changed as of today PER MD, now to apply Medihoney to the wound bed; A named medical practice to further assess the wound and pending new orders. Patient tolerated well wound care, and will continue wound are three times weekly until further notice.” Order dated and signed on 10/14/2025 MD update/summary: Multiple lesions to arms, hands, legs, and exposed skin to the torso/change in medication to sacral wound, Order: Sn to provide wound care to sacrum three times weekly using aseptic technique, cleanse with normal saline/wound cleaner, pat dry gently apply small amount of Medihoney to wound bed cover with sacral foam dressing. Caregiver to perform wound care when SN is not available. SN to instruct, assess, or observe for performance of proper wound care. SN to discontinue wound care and all associated treatment when healed. Caregiver to apply bacitracin ointment over affected areas/the lesions on the body twice daily until clear. Caregiver to provide good hygiene to the patient daily and as needed. GOAL: skin dry, scabbed, scaly lesions to clear, and the sacrum to stay free from infections and without complications. 10/23/2024 LVN nursing assessment stated “Sacral wound treatment cleansed with wound cleanser, pat dry; packed with Iodoform gauze tunneled area—Applied Silvadene cream with alginate to the base of the wound and secured with Mepilex. Right great toe wound treatment: cleansed the right great toe with normal saline, patted dry; applied Medihoney to the wound bed, covered with clean 4x4 gauze, and taped down with tape to secure. The wound care and treatments provided by the LVN were not included in the interdisciplinary plan of care and physician orders. During an interview with the Administrator on 07/16/2025, she verified that the LVN did not follow the physician’s orders and the plan of care. She stated that they are providing additional education to clinical staff regarding care plans. She also stated that they had self-identified this issue and had been working on it since February 2025.”

“It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care; ensure continuous assessment of each patient’s and family’s needs; and ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed revealed that the hospice did not ensure that services were consistent with the interdisciplinary plan of care. CLINICAL RECORD 2: Clinical record review lacked evidence of supervision by the registered nurse to ensure that the nursing needs of the patient were met as identified in the patient’s assessments. 10/21/2024 nursing assessment states “SN provided wound care to the sacrum, medication changed as of today PER MD, now to apply Medihoney to the wound bed; A named medical practice to further assess the wound and pending new orders. Patient tolerated well wound care, and will continue wound are three times weekly until further notice.” Order dated and signed on 10/14/2025 MD update/summary: Multiple lesions to arms, hands, legs, and exposed skin to the torso/change in medication to sacral wound, Order: Sn to provide wound care to sacrum three times weekly using aseptic technique, cleanse with normal saline/wound cleaner, pat dry gently apply small amount of Medihoney to wound bed cover with sacral foam dressing. Caregiver to perform wound care when SN is not available. SN to instruct, assess, or observe for performance of proper wound care. SN to discontinue wound care and all associated treatment when healed. Caregiver to apply bacitracin ointment over affected areas/the lesions on the body twice daily until clear. Caregiver to provide good hygiene to the patient daily and as needed. GOAL: skin dry, scabbed, scaly lesions to clear, and the sacrum to stay free from infections and without complications. 10/23/2024 LVN nursing assessment stated “Sacral wound treatment cleansed with wound cleanser, pat dry; packed with Iodoform gauze tunneled area—Applied Silvadene cream with alginate to the base of the wound and secured with Mepilex. Right great toe wound treatment: cleansed the right great toe with normal saline, patted dry; applied Medihoney to the wound bed, covered with clean 4x4 gauze, and taped down with tape to secure. The wound care and treatments provided by the LVN were not included in the interdisciplinary plan of care and physician orders. During an interview with the Administrator on 07/16/2025, she verified that the LVN did not follow the physician’s orders and the plan of care. She stated that they are providing additional education to clinical staff regarding care plans. She also stated that they had self-identified this issue and had been working on it since February 2025.”