Every finding on record at Hospice of the Red River Valley

Based on observation, policy review, record review, and staff and family interview, the Hospice failed to update the plan of care for 1 of 20 sampled patients (Patient #3) currently receiving Hospice services. Failure to review and revise the plan of care with information from the patient's updated comprehensive assessment limited the staff's ability to communicate treatment approaches and interventions to ensure continuity of care. Findings include: Review of the agency's policy titled "Plan of Care" occurred on 01/20/22. This policy, revised January 2020, stated, "The care and services provided to patients and their families are in accordance with an individualized plan of care . . . The plan of care is reviewed and updated by the HRRV [Hospice of Red River Valley] IDG [Interdisciplinary group] every fifteen (15) days or more frequently if needed. . . . Revisions to the plan of care are based on information from the patient's updated comprehensive assessment . . ." Observation of Patient #3 occurred on 01/18/22 at 2:00 p.m. during a home visit with a certified nurse aide (CNA) (#1). Observation showed Patient #3 on her bed, eyes shut, and oxygen on at two liters per nasal cannula. The patient's daughter stated her mom always keeps her eyes closed as she is blind. The patient requested a shower. The CNA removed the gauze and elastic bandages from around Patient #3's lower legs and both her hearing aids. The patient started to walk in the wrong direction until the CNA cued and guided her into the bathroom. Review of Patient #3's medical record occurred on January 19-20, 2022. The RN (Registered Nurse) Comprehensive Assessment, dated 12/21/21, stated, ". . . hearing difficulty, visual impairment . . . hearing aid left, hearing aid right . . . pitting edema to BLE [bilateral lower extremities]. BLE are weeping [oozing fluid]. . . . New order received: Apply Kerlix and ACE wraps [types of gauze/bandages] to BLE daily and as needed. Put on in the am [morning]/take off at bedtime. . . ." The RN Comprehensive Assessment, dated 12/28/21, stated, ". . . Pulse Oximetry 90% [percent] per nasal cannula. Comment: O2 [oxygen] was 60-72% on room air. Writing nurse applied oxygen at 2L [Liters] per nasal cannula. It took ten minutes for the patient to recover to 90% [normal range]. . . ." Review of Patient #3's current plan of care showed the facility failed to include information related to her limited vision, use of hearing aids, leg wraps, and oxygen use. During an interview on 01/20/22 at 2:15 p.m., a nurse (#2) and a clinical support specialist (#3) reviewed Patient #3's record and stated her elastic leg wraps started on 12/21/21 and the oxygen on 12/28/21 and agreed the agency staff should have included these items on the comprehensive care plan, along with the patient's limited vision. Failure to include pertinent information in Patient #3's plan of care (limited vision and use of hearing aids) may have hindered hospice medical providers, social workers, chaplains, and/or nursing staff from effectively communicating with the resident. Failure to include treatments related to leg wraps and oxygen use may have resulted in lack of or inadequate care.

Based on observation, record review, and family and staff interview, the Hospice failed to ensure the hospice aide received specific patient care instructions for 1 of 18 patient (Patient #3) records reviewed receiving hospice aide services. Failure to ensure the aide care plan included instructions specific for each resident had the potential to limit the quality of care and services provided by the aide. Findings include: Observation of Patient #3 occurred on 01/18/22 at 2:00 p.m. during a home visit with a certified nurse aide (CNA) (#1). Observation showed Patient #3 on her bed, eyes shut, and oxygen on at two liters per nasal cannula. The patient's daughter stated her mom always keeps her eyes closed as she is blind. The patient requested a shower. The CNA removed the gauze and elastic bandages from around Patient #3's lower legs and both her hearing aids. The patient started to walk in the wrong direction until the CNA cued and guided her into the bathroom. After the shower, the CNA (#1) obtained new gauze and wrapped Patient #3's legs with the gauze and elastic bandages and replaced the hearing aids in Patient #3's ears. Review of Patient #3's medical record occurred on January 19-20, 2022. The RN (Registered Nurse) Comprehensive Assessment, dated 12/21/21, stated, ". . . hearing difficulty, visual impairment . . . hearing aid left, hearing aid right . . . Apply Kerlix and ACE wraps [types of gauze/bandages] to BLE [bilateral lower extremities] daily and as needed. Put on in the am [morning]/take off at bedtime. . . ." The RN Comprehensive Assessment, dated 12/28/21, stated, ". . . applied oxygen at 2L [Liters] per nasal cannula. . . ." Patient #3's CNA plan of care failed to include information related to her vision impairment, hearing aids, leg wraps, and oxygen use. During an interview on 01/18/22 at 3:05 p.m., a CNA (#1) stated the plan of care on our I-pad "tells us (aides) what care we can provide" the patient. During an interview on 01/20/22 at 11:55 a.m., a nurse (#2) agreed the agency failed to individualize Patient #3's CNA plan of care with personal information important for the aides to know, such as blindness, and orders for oxygen with liter flow and the method of administration (nasal cannula), and leg wraps.