Every finding on record at Howard County Home Health and Hospice

Based on policy review, employee file review, and interview, the hospice provider failed to ensure EP (Emergency Preparedness) training was documented every two years on one of five employee files reviewed (Medical Director). This deficient practice has the potential to delay staff response in the event of an emergency and affect all the patients served by the provider. --- Findings included: Review of the providers policy titled, ";Emergency Preparedness Plan Orientation and Training Policy," dated most recently revised 10/28/2021, showed in part, all employees will be oriented to the Emergency Disaster Plan (EDP), including their responsibilities in carrying out the plan, upon hire, and will participate in Agency (Provider) plan in-service educational sessions annually. Review of the Medical Directors employee file showed: - Date of hire: 09/27/2011; and - It failed to contain documentation of every two-year EP training. During an interview on 05/22/2024 at 9:10 AM, the administrator stated that he/she was ";unable to locate any documented EP annual training." During an interview on 05/22/2024 at 9:51 AM, the administrator stated that he/she would expect EP training documented at least every two years.

Based on policy review, record review, observation, and interview, the hospice provider failed to ensure staff maintained an accurate and updated medication profile in, but not limited to, two of four home visit observations (Records/Patients #1 and #4). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the providers undated policy titled, ";Medication Policy," showed in part: - A complete medication evaluation will be done on admission and at least every 15 days; - The physician will be notified of any discrepancies that are discovered; and - The patients in-home medications will be evaluated periodically and updated in clinical software to be accurate. --- RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice 05/05/2023 with malignant neoplasm of the bladder (bladder cancer), secondary malignant neoplasm of the lung (lung cancer), malignant neoplasm of the vertebral column (cancer of the back bones), hematuria (blood in the urine) and Parkinsons disease (a neurological disorder that causes unintended or uncontrollable movements or stiffness). The patient resided at home with their spouse. Observation on 05/20/2024 at 1:10 PM, during the patients home visit, showed: - The patients home medication list showed famotidine 10 mg (milligram) (used to treat stomach ulcers and acid reflux) take one at bedtime and the providers medication profile showed famotidine 10 mg take one tablet twice a day; and - The patients home medication list showed clonazepam 1mg at bedtime and the providers medication profile showed clonazepam 1mg one tablet by mouth every four hours as needed for moderate anxiety or nightmares and clonazepam 1mg two tablets every four hours as needed for severe anxiety or nightmares. Per interview conducted during the home visit observation the patients spouse stated that the home medication list is what ";named nurse" used to fill the med planner weekly. During an interview on 05/22/2024 starting at 9:55 AM the administrator stated that they (the provider) will clarify the medication discrepancies. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to hospice services on 05/11/2024 with a terminal diagnosis of malignant neoplasm of the prostate (prostate cancer that has spread from the original site). The patient had additional diagnoses of secondary malignant neoplasm of the lymph nodes of multiple regions (cancer that has spread to the lymph nodes), dementia, alcohol abuse, and obstructive sleep apnea (the interruption of breathing during sleep). The patient lived in his/her own home with his/her spouse. Observation and interview on 05/21/2024 at 9:30 AM, during the patients home visit, showed patients home medications contained hyoscyamine 0.125 mg, one to two tablets sublingual (under the tongue) every hour as needed for oral secretions and the providers medication profile failed to include this medication. During an interview on 05/22/2024 at 10:00 AM, the administrator stated that he/she may have ";goofed" and left the hyoscyamine off the list, but it should have been included on the medication profile.

Based on policy review, record review, and interview, the hospice provider failed to ensure that the plan of care included that the provider was responsible for filling the medication planner weekly in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect the care planning for all the provider's patients. --- Findings included: Review of the provider's policy titled, "Comprehensive Plan of Care," dated 08/08/2001, showed in part: - The interdisciplinary team develops and maintains the comprehensive plan of care for each patient ";within seven (5) days" of admission (possibly a typo on the providers policy); - The development and changes in the plan of care are done by the interdisciplinary team at regular team meetings; - The comprehensive plan of care includes: *Complete assessment and identification of patient and family needs; *Problem identification and treatment goals; and * Services required to meet the goals; and - Hospice provides care in accordance with the comprehensive plan of care and with collaboration from the patient and family. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice services on 05/05/2023 with malignant neoplasm of the bladder (bladder cancer), secondary malignant neoplasm of the lung (lung cancer), malignant neoplasm of the vertebral column (cancer of the back bones), hematuria (blood in the urine) and Parkinsons disease (a neurological disorder that causes unintended or uncontrollable movements or stiffness). The patient resided at home with their spouse. Review of the most current team care plan, dated as of 05/20/2024, failed to include filling the patients medication planner weekly. Review of the SN (skilled nurse) clinical note, dated 05/03/2024, showed med (medication) box prefilled. Review of the SN clinical note, dated 05/10/2024, showed med box filled. Review of the SN clinical note, dated 05/17/2024, showed pill box filled. Per interview conducted during the patients home visit on 05/20/2024 starting at 1:10 PM, the patients spouse stated that ";named nurse" filled the med (medication) planner weekly. During an interview on 05/22/2024 starting at 9:55 AM, the administrator stated that filling the medication planner weekly should have been on the plan of care.

Based on review of the Centers for Disease Control and Preventions (CDC) guidelines, policy review, record review, observation, and interview, the hospice provider failed to ensure staff changed their gloves and performed hand hygiene in one of four home visit observations conducted (Record/Patient #3) and failed to ensure staff did not place themselves on the patients floor in one of four home visit observations conducted (Record/Patient #2). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the CDCs guidance titled, ";Precautions to Prevent Transmissions of Infectious Agents," dated 11/22/2023, showed in part: - Standard Precautions combine the major features of universal precautions and body substance isolation and are based on the principle that all blood, body fluids, secretions, excretions, nonintact skin, and mucous membranes may contain transmissible infectious agents; - Standard precautions are intended to be applied to the care of all patients in all healthcare settings, regardless of the suspected or confirmed presence of an infectious agent; - Equipment or items in the patient environment likely to have been contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents (wear gloves for direct contact, contain heavily soiled equipment, properly clean and disinfect or sterilize reusable equipment before use on another patient); and - Standard precautions are also intended to protect patients by ensuring that healthcare personnel do not carry infectious agents to patients on their hands or via equipment used during patient care. Review of the CDCs guidance titled, ";Standard Precautions for All Patient Care," dated 04/03/2024, showed in part, standard precautions are used for all patient care. They are based on a risk assessment and make use of common-sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread from patient to patient. Review of the hospice providers policy titled, ";Infection Control Program," dated 08/18/2015, showed in part, the provider will follow the CDCs universal infection control precautions. Review of the hospice providers policy titled, ";Infection Prevention and Control," dated 05/22/2024, showed in part: - Staff will wear gloves in the event that they have the potential to be exposed to body fluids; and - They (staff) will wash their hands after the removal of gloves as an added precaution. --- RECORD/PATIENT #2: Observation on 05/21/2024 beginning at 9:30 AM, during the patients home visit, RN A was observed, while removing the patients shoes, to sit down on the floor of the patients home. Per interview conducted during the home visit observation RN A stated that he/she probably shouldnt have done that. During an interview 05/22/2024 starting at 9:55AM the administrator stated that: - He/she had sat on the floor for years during patient home visits; - My nurse (RN A) is ";beating themselves up about it"; - We have ordered a stool; and - ";I understand your point". RECORD/PATIENT #3: Review of the clinical record showed the patient was admitted to hospice with a terminal diagnosis of malignant neoplasm of the rectum (cancer that has spread to other parts of the body), rectal fistula (an abnormal connection between two body parts). The patient had additional diagnoses of malignant neoplasm of the right breast and hypertensive heart disease with heart failure (heart disease caused by high blood pressure). The patient had a urinary catheter, was bedbound and was cared for in his/her home by a sibling. Observation during the patients home visit showed the licensed practical nurse (LPN-A) performed the following actions wearing the same pair of gloves: - Prepared a basin of bath water; - Washed the front of the patients body which included urinary catheter care; - Reached into his/her scrub pocket and removed a tissue; - Wiped the sweat from his/her face with the tissue; - Placed the tissue back into his/her pocket; - Grabbed the bath basin and refilled it with more bath water; - Returned to the bedside, rolled the patient over onto their side; - Washed the back of the patients body; - Applied lotion to the patients back; - Repositioned the patient in the bed and applied lotion to arms and legs; - LPN-A failed to remove gloves and perform hand hygiene when moving from soiled areas of the body to clean areas of the body; - LPN-A failed to remove gloves and perform hand hygiene after patient contact and before wiping his/her own face with a tissue; and - LPN-A failed to remove gloves and perform hand hygiene after wiping his/her face and before he/she continued bathing the patient. During an interview immediately following the home visit, LPN-A stated that he/she thought that he/she should not have left on the soiled gloves when he/she wiped his/her face, but it was after he/she had already done it. He/she was just so hot and did not want to drop sweat on the patient. During an interview on 05/22/2024 at 10:00 AM, the administrator stated that LPN-A told him/her what he/she had done, and he/she would have expected LPN-A to change gloves when they are soiled and saw why it was a problem.