Every finding on record at Hospice of North Ottawa Community, Inc.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted that there was no frequency ordered for MSW services during review of record #4. This was confirmed by the hospice leadership assisting with record review.

Observed in Record Review. In 2 of 16 patient records reviewed, it was noted in review of record for hospice visit #1 that the patient was receiving ace wraps for treatment of lymphedema. This was not included in the hospice plan of care. In another example, in record review #6 it was noted that the plan of care indicated that the nurse was to teach about blood glucose monitoring, keeping a blood sugar log, and safe administration of insulin however although the patient had a diabetes diagnosis, there were no orders for glucose monitoring or insulin orders and she was not monitoring blood sugars and not receiving insulin. This was confirmed by hospice leadership assisting with record review.

Observed in Record Review. In 3 of 16 patient records reviewed, it was noted in review of record for home visit #2 that a newly developed issue of temporary limited use of left hand as reported by skilled nursing facility staff was not added to the care plan as a problem with interventions and goals. In another example, in review of record for home visit #4 it was noted that an antibiotic was ordered for a wound infection to the great toe however the care plan was not updated to include this new problem, interventions or goals. In another example, in record review #10 it was noted that the plan of care was not updated and still included wound care orders however the wound is healed. This was confirmed by hospice leadership assisting with record review.

Observed in Patient Home. In 2 of 2 home visits conducted, by a skilled nurse it was noted that a complete skin assessment was not done. For example, the plan of care stated, skilled nurse for observation/assessment of integumentary status for early identification of complications. In home visits #1 and #2 for patients that were primarily bed or chairbound and incontinent the nurse did not assess the skin on the back or buttocks during her weekly visit. This was confirmed by the Clinical Manager present on the visit.

Observed in Record Review. In 1 of 16 patient records reviewed, it was noted in review of record for home visit #2 that there was no documentation that the physician was notified of temporary limited use of left hand as reported by skilled nursing facility staff. This was confirmed by hospice leadership assisting with record review.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted that bag technique was not performed according to agency protocol. For example, during home visit #1 the nurse was observed cleaning her equipment with a large alcohol wipe which was used on all equipment and then used to wipe down the disinfection wipes cannister followed by directly placing the cannister while still holding the wipe in her hand, back into the clean portion of the bag. This was observed by the Clinical Manager present on the visit.

Observed in Record Review. In 2 of 16 patient records reviewed, it was noted in record review #5 and record review for home visit #2 that supervisory visits were made 15 days apart. This was confirmed with hospice leadership assisting with record review.

Observed in Tracer Visit. In 2 of 16 patient records reviewed, it was noted that in record review for home visit #1, the patient medication sheet at the skilled nursing facility did not contain a medication Occusoft eyelid scrub that was listed as a current medication on the Hospice medication list. In another example, in home visit #2 it was noted that there were discrepancies between the ALF medication sheet and the hospice medication sheet. For example, on the hospice medication list Bisacodyl 10 mg suppository was listed as a regularly scheduled medication 2 x per week but the ALF medication sheet listed it as a PRN medication. Also, Systane eye drops were on the hospice medication list as duplicatable at Bedtime and as Daily. This was observed by the Clinical Manager present on the visit.