Every finding on record at Hospice of North Central Ohio, Inc.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by a review ofclinical records and interviews. 8 of 10 (80%) of applicable records in which patient's received aide services revealed that the agency did not ensure that clear and specific patient care instructions for a hospice aide were provided. Clinical Record 7 Aide care plan dated 3/28/2022 and updated 6/22/22 reads HCA Orders, "assist with personal care". There are no specific tasks or instructions assigned. The aide care plan does include aspiration precautions on oxygen precautions, but there is no specific instruction to the aide related what to do with oxygen while performing care. No instructions are included related tub, shower, bed bath. No explanation is included to indicate what personal care is to be provided. Clinical Record 1 Record #3: Aide care plan is not clear and specific. Aide care plan dated 6/11/2022 with update on 7/21/2022 lists the following activities as HCA orders; Assist with tub/shower bath, partial or complete bed bath, tub or shower bath, seated shower. SN Assessment and Plan of care dated 6/11/2022 state that patient has a foley catheter, g-tube, wound dressing, and oxygen. Aide care plan does not provide direction on oxygen use, g-tube, foley catheter or decubitus dressing. Clinical Record 10 SN assessment on 4/8/22 reveals that patient is utilizing oxygen. Plan of care dated 4/8/22 and recertification dated plan of care dated 7/7/2022 contain orders for oxygen at 2-5l inhalation continuous, may be dispensed via NC or mask. Aide care plan dated 4/8/22 and updated 6/28/22 does not include instructions to the aide related to oxygen. Aide care plan task list updated 6/28/2022 is not clear and specific and states "tub or shower bath". Aide documentation on 8/19/2022, 8/17/22, and 8/11/2022, as examples, all read, Tub or Shower Bath performed without specific documentation of whether the patient was given a bath or shower. Clinical Record 4 Aide care plan dated 6/27/2022 includes HCA orders to assist with Partial/complete bed bath and assist with personal care. No other tasks exist on aide care plan. Aide note on 8/19/2022 states in part, shaved face, although shaving is not specific in aide care plan. Aide note on 8/10/2022, aide documented taken to restroom, pericare given and patient was shaved. Clinical Record 8 SN assessment on 2/9/2022 states the need for patient to begin utilizing oxygen. AIde care plan dated 1/14/2022 has no updates for change in condition and does not provide any instruction to aide related to oxygen. Clinical Record 12 Patient admitted on 5/19/2022 with exacerbation of shortness of breath beginning 7/27/2022 with new orders for oxygen. RN notes on 7/30/2022 and 8/3/2022 reveal that patient is using oxygen. Aide care plan updated 8/3/2022 has no HCA orders or tasks related to oxygen. Clinical Record 0 Record #11: Rn assessment on 2/9/2022 reveals that patient has a foley catheter. Aide care plan dated 2/14/2022 includes HCA orders for partial complete bed bath, assist with personal care and Partial bed bath, patient prefers afternoon. There is no mention of foley catheter or foley care needed. Plan of care dated 2/9/2022 includes orders for foley catheter to continuous drain. Plan of care dated 2/9/2022 also includes orders wound care on posterior right gluteus maximus, but there is no direction on the aide care plan related to the wound areas. SN visit note reveals that patient began using oxygen on 2/18/2022. There is no mention or directions related to oxygen on aide care plan. Clinical Record 9 Aide care plan updated 8/12/2022 does not include instruction to the aide regarding oxygen. Plan of care dated 5/25/2022 through 8/22/2022 and plan of care dated 8/23/2022 through 10/21/2022 include orders for Oxygen 2-5 L inhalation continuous. During Home visit observed patient wearing oxygen. Plan of care dated 8/23/2022 includes new orders for pressure injury on posterior left buttocks to include crushed flagyl, calcium alginate and cover with optifoam dressing. There are no updates or orders on the aide care plan to provide instruction or direction to the aide related to the dressing should it become soiled or disrupted during bathing. Interview with Director of Clinical Services In interview on 8/23/2022, Director of Clinical Services stated that agency has been providing education to staff related to being more specific on aide care plans. Stated that this is a new electronic medical record system and staff are still learning to navigate the fields. 8 of 10 (80%) of applicable records in which patient's received aide services revealed that the agency did not ensure that clear and specific patient care instructions for a hospice aide were provided.