Every finding on record at Hospice of Central Ohio

Observed in Record Review. In 4 of 20 patient records reviewed, the surveyor noted that the organization had not conducted a comprehensive assessment and/or reassessment per organization requirements. For example, in review of the medical record for RR5, the organization had not completed a Braden skin breakdown risk assessment even though the overall condition of the patient indicated a need to assess this risk. In review of the medical records for RR7 and RR8, wound measurements were not obtained and documented at least every 14 days. The team leader assisting with record review stated that these items were organizational expectations.

Observed in Record Review. A review of the medical record for HV#5, revealed that during week #4 of the first benefit period the clinician documented the presence of a stage 2 wound at the coccyx area. The assessment of the wound did not include the measurement of wound size.

Observed in Patient Home. In 2 of 5 home visits conducted, the surveyor found that the organization had not conducted a comprehensive drug regimen review. For example, during the home visit for HV2, the patient stated she has taken Metamucil on a daily basis for years. This medication was not identified as part of the patient's drug regimen either at the time of admission or on subsequent visits. During the home visit for HV3, the surveyor observed the staff member fill the patient's medication box. In review of the medications, the surveyor noted that Ropinirol was listed on the medication profile as scheduled but on the bottle as needed. The staff member stated the medication had been set up as a scheduled medication since admission but had not changed the schedule with the pharmacy provider. Lantus insulin was listed to the medication profile with directions to inject 45-50 units without further defining when to give each dose. The medication package directions were to inject 50 units and the patient stated that she only injects 45 units. These discrepancies had not been addressed at the time of admission or on subsequent visits. This was discussed with the staff member present during the visit.

Observed in Record Review. In 2 of 20 patient records reviewed, the hospice surveyor noted that the organization had not developed measurable outcomes for each problem identified. For example, in review of the medical record for RR1, the surveyor noted the presence of outcomes that were not measurable to include the following: Optimal spiritual support; skin breakdown minimized; wound managed for patient comfort. These were discussed with the staff member assisting with record review. In review of the medical record for RR5, the plan of care had identified interventions for pain management but there was no current goal.

Observed in Record Review. In 3 of 20 patient records reviewed, the surveyor found that the plan of care did not include all interventions needed to manage pain and symptoms identified in the comprehensive assessment. For example, in review of the medical record for RR2, it was noted that the patient had a Braden score of 6 but the risk for skin breakdown was not addressed. This was discussed with the team leader assisting with record review. In review of the comprehensive assessment for RR4, the patient was assessed as having an issue with pain. This was not addressed in the plan of care. In review of the record for RR6, the patient was noted with dressings to wounds on the coccyx and right heel as well as a foley catheter being in place. There were no orders for wound care or catheter management.

Observed in Record Review. In 2 of 20 patient records reviewed, the surveyor found that the plan of care did not include all information on medications and treatments needed to meet the needs of the patient. For example, during the home visit for HV3, the surveyor noted that the patient had both tramadol and hydrocodone 10/325 present. In review of the medical record for HV3, the surveyor found that both medications were ordered as needed for pain without further defining when to give each medication. This was discussed with the staff member at the time of the visit. In review of the medical record for RR4, the surveyor found that the nurse documented that the patient was using Tylenol for pain but this medication was not present on the plan of care/medication profile.

Observed in Patient Home. In 1 of 5 home visits conducted, the surveyor observed that the staff member did not follow the organization's policy 10378871, Hand Hygiene. For example, during the home visit for HV2, the surveyor observed the staff member wash her hands with liquid soap found at the patient's sink and then turned the faucet off with her wrist. She then obtained a paper towel present at the patient's sink, dried her hands but used her bare hand to open the trash can and dispose of the used paper towel. Organization policy required the use of a paper towel to turn off the faucet. In discussion with leadership, the surveyor also found that the expectation was for the staff member to use the organization supplied soap and to ensure it was not past its expiration date prior to use.

Observed in Record Review. In 5 of 14 patient records reviewed, where the patient had hospice aide services ordered, the surveyor found that the registered nurse had either not updated the aide plan of care for changes in the patient's condition or had not provided the aide with specific information on safety precautions to implement or when to notify the nurse. For example, in review of the medical record for RR5, the aide plan of care had not been updated to identify the removal of the foley catheter and that there was no longer a need for catheter care. In review of the medical record for RR6, the patient had wound dressings to his coccyx and right heel but the aide plan of care did not specify the unique safety precautions or notification requirements related to this. In review of the medical record for RR8, the patient had wound dressings and foley catheter but the aide plan of care did not specify the unique safety precautions or notification requirements related to these. In review of the medical record for RR9, the patient had an anticoagulant ordered but the aide plan of care did not specify the unique safety precautions or notification requirements related to this. In review of the medical record for RR12, the aide plan of care provided instructions related to the patient's dressing but the patient did not have a dressing ordered. These findings were discussed with the team leader assisting with record review.

Observed in Record Review. In 1 of 20 patient records reviewed, the surveyor noted that the record did not contain specific notes on care provided to the patient. For example, in review of the medical record for HV2, there were multiple notes where the documentation had that the pleurix was drained per order and the dressing was changed per the careplan without being further described. In discussion with the team leader assisting with record review, the surveyor learned that this documentation did not meet the expectation of the organization.