Every finding on record at Hospice of Wichita Falls, Inc.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed, the agency did not ensure that the written plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 6: The patient elected the hospice benefit on 3/31/23, with the diagnosis of malignant neoplasm of the lung. The Registered Nurse (RN) visit note dated 10/3/23 documented, "O2 (oxygen), 2L (liters) via N/C (nasal cannula) continuous, dyspnea present...patient lying in semi-fowler's position taking her oxygen on and off...Patient has foley catheter in place draining yellow urine via gravity.” The RN visit note dated 10/12/23 documented, “she does get SOB (short of breath) with minimal exertion; she is currently wearing her O2 at 2 LPM via N/C...Foley cath is patent and drainage clear urine with small amount of sediment assessed. Nurse removed current cath and replaced using aseptic technique.” The plan of care for benefit period three (3), dated 9/27/23 through 11/25/23, did not document problems, goals, or interventions to address the care of the patient's dyspnea or urinary catheter care. Clinical Record 18: The patient elected the hospice benefit on 8/7/21 with a diagnosis of legal blindness. The comprehensive assessment completed by the RN on 10/24/23 documented, “(patient name) is blind and uses a walking stick.” On 10/27/23, the Chaplain visit note documented, "Patient is blind and had misplaced the 45 adapter for her record player.” The comprehensive assessment completed by the RN on 11/8/23 documented, "She remains high fall risk... she is blind, slow/shuffled gait and stooped posture.” The plan of care for benefit period thirteen (13), dated 10/16/23 through 12/14/23, did not document problems, goals, or interventions to address the patient's legal blindness. During an interview on 11/9/23, the Director of Clinical Services confirmed that Record 6 did not document problems, goals, or interventions to address the patient's dyspnea or urinary catheter care, and Record 13 did not document problems, goals, or interventions to address the patient's blindness.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as, hand hygiene. This standard was not met as evidenced by document review, interview, and observation. In 2 of 6 (33%) home visits observed, the agency did not ensure that hand hygiene was performed as indicated per the agency's policy. Agency policy "Infection Control-Hand Hygiene" (undated) stated in parts, "Hospice follows the hand hygiene guidelines recommend by the Centers for Disease Control and the World Health Organization... Hospice staff must wash hands c. after performing tasks that involve risk of exposure to body fluids; e. before and after wearing gloves." Home Visit 2: During the home visit on 11/7/23 with the Licensed Vocational Nurse (LVN) [Personnel Record 17], the LVN doffed their gloves and donned clean gloves twice during the assessment and care of the patient. The LVN did not perform hand hygiene before and after wearing gloves. Home Visit 4: During the home visit on 11/7/23 with the Registered Nurse (RN) [Personnel Record 5], the RN doffed their gloves and donned clean gloves twice during patient care, once after assisting the patient in toileting and changing an incontinence brief. The RN did not perform hand hygiene before and after wearing gloves. During an interview on 11/7/23, the Director of Clinical Services (DCS) confirmed that the LVN and RN did not follow standard precautions and the agency policy for hand hygiene.