Every finding on record at Dickinson County Healthcare System

Observed in Patient Home. In 1 of 3 home visits conducted, The organization failed to provide patient education and training based on each patient’s needs and abilities per Medication Policy No 3-002-1, as evidenced by HOSRRHV#3 there was no written list/education on morphine sulfate which is a high risk medication, this was validated by Administrator

Observed in Individual Tracer. In 10 of 10 patient records reviewed, The HCO failed to create measurable outcomes and goals as evidenced by all goals in charts reviewed were to be achieved by the end of the certification period, yet all were not appropriate for that length of time. Example in HOS RRHV#1 goal was : patient at risk for UTI/r/t disease progression, problem UTI/urinary elimination and patient has had no UTI since soc of care in 2024. HOSRRHV#2 patient/CG will engage in conversation about funeral arrangements within 2 weeks since SOC in 2024. HOSRRHV#3 pain will be controlled at a tolerable level of 0-4 since SOC in 2024 and within 1 cert period since SOC. HOSRRNHV#1 Patients SOB on the Edmonton scale was 6/10 and goal was patient at risk for respiratory distress r/t COPD and increase in secretions. HOSRRNHV#2 patient is alert and orientated at SOC and goal is patient at risk for confusion related to the se disease process, and progression. HOSRRNHV#3 patient rates SOB 5 on Edmonton scale: goals, goal is that patient with End stage COPD, symptoms to be managed within episode. HOSRRNHV#4: : Pain management within home setting to a tolerable level. within cert period and pain rated pain a 5 @ SOC HOSRRNHV#5: Patient with stg 4 lung cancer, respiratory symptoms to be managed within episode. HOSRRNHV#6: Patients pain will be controlled within home during episode. and patient rated her pain a 7/10. HOSRRNHV#7 the patient rated his pain an 8/10 and goal was : patients pain will be well managed throughout the episode This was validated by Administrator

Observed in Record Review. In 2 of 10 patient records reviewed, The organization failed to review orders and prescriptions for appropriateness and accuracy before providing care, treatment, or services as evidenced that in both cases there was no clarification to use as evidenced in HOSRRHV#2 the order for oxygen was incomplete: it states 2-5 litres continuous. In HOSRRHV#3 morphine sulphate ordered 0.5mls- 2mls q 2 hourly PRN for pain rating of 5-10/10, this was validated by the Administrator

Observed in Patient Home. In 1 of 3 home visits conducted, The HCO implements activities for the prevention of infection, including the use of standard precautions as evidenced by in HOSHV#2 the RN failed to perform hand hygiene consistent with Hand Hygiene Policy No 9-009., the RN petted the patients dog on the bed, then worked on her computer and placed cleaned equipment back in the medical bag without cleaning her hands first, this was validate by the Administrator

Observed in Competency Session. The HCO had an incomplete contract evidenced by the Medical Director's contract was not dated, this was observed and validated by the Administrator

Observed in Record Review. In 2 of 12 patient records reviewed, The HCO did not maintain a current accurate record as evidenced in HSPRRHV#! ; one IDG note contained information from another patient, included summary of the other patients IDG notes and corrected on site In HOSRRDC#2, the revocation order date was inaccurate as it was documented the day before the revocation which aligns with the patients hospital admission, this was observed and validated by Administrator

Observed in Record Review. In 7 of 10 patient records reviewed, the organization did not plan the patient's care by ensuring the written plan of care was based on the patient's goals and the timeframes required to meet those goals. In RRHV#1, RRHV#2, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, and RRNHV#6 the patient's plan of care did not include short term goals, including for pain and other symptom management. All timeframes for goals to be achieved were documented to be within the hospice certification period. This was reviewed and verified with the Administrator.

Observed in Record Review. In 3 of 10 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient's needs. In RRHV#3 and RRNHV#3, the patient's plan of care included Morphine Sulfate (Concentrate) Oral Solution and Hydrocodone-Acetaminophen Oral Tablet 5-325 MG ordered as needed for pain with no clear indications for use (which prn analgesic to take when). In RRNHV#4, the patient's plan of care orders included Morphine Sulfate Oral Solution prn and Norco prn for pain with no clear indications for use. This was reviewed and verified with the Administrator.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not implement infection prevention and control activities when cleaning and performing disinfection of medical supplies and devices to reduce the risk of infections. In RRHV#1 and RRHV#2, the registered nurse cleaned the care equipment before placing the items back into the field bag, but did not disinfect the cell phone and electronic tablet device after use according to the organizational policy. This was reviewed and verified with the Administrator.

Observed in Record Review. In 2 of 10 patient records reviewed, the registered nurse did not supervise the hospice aide during an on-site home visit at least every 14 days to assess the quality of care/services provided by the aide and ensure the services ordered met the patient's needs. In RRHV#3 and RRNHV#1, the registered nurse did not perform/document hospice aide supervision consistently every 14 days, with 20 days or more between supervisory visits noted. This was reviewed and verified with the Administrator.

Observed in Record Review. In 10 of 10 patient records reviewed, the medical director, physician member of the interdisciplinary team, or physician designee did not review the clinical information for each hospice patient and provide written certification that the patient's life expectancy was six months or less if the illness ran its normal course. In RRHV#1, RRHV#2, RRHV#3, RRNHV#1, RRNHV#2, RRNHV#3, RRNHV#4, RRNHV#5, RRNHV#6, and RRNHV#7, it was noted the hospice medical director did review the clinical information of each patient and sign the Certificate of Terminal Illness (CTI), but did not document a written narrative that included the required elements/factors needed for determination of the patient's life expectancy. This was reviewed and verified with the Administrator.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not provide education and training based on each patient's needs and abilities, including procedures to follow if care, treatment, or services were disrupted by a natural disaster or emergency. In RRHV#1 and RRHV#2, the patient's individual home evacuation/emergency plan and related education was not provided to the patient/family. This was reviewed and verified with the Administrator