Every finding on record at Mercy Health Services - Iowa Corp

Observed in Record Review. In 3 of 16 patient records reviewed, it was noted in hospice record review #1 that no bereavement risk assessment was documented at the start of care. This was particularly significant because the patient was 49 years old and had several children and a significant other. Additionally, there was no bereavement risk assessment in hospice record review #9 and #10. This was confirmed by the RN assisting with record review.

Observed in Record Review. In 4 of 16 patient records reviewed, it was noted that in record review for hospice home visit #1 the oxygen order read as follows: Oxygen 2-5 L via nasal cannula for dyspnea as needed. Titrate for Comfort There were no other parameters given for the titration. In review of hospice discharge record #2 it was noted that the patient revoked hospice care however there was no discharge order signed by the physician. In record review #5 and #8 it was noted that the plan of care did not include any management of the G-tube. This was discussed with interim director.

Observed in Record Review. In 4 of 16 patient records reviewed, it was noted that new problems had not been added to the plan of care to include goals. For example, in review of record for hospice home visit #1, the patient had fallen and sustained new skin tear wounds however there were no goals added to the plan of care for this new problem. In review of record for hospice home visit #2 the patient had new skin breakdown and developed thrush however there were no goals added to the plan of care for these new problems. In hospice record review #2 it was noted that the plan of care was not updated when the patient developed a new wound on his nose from use of oxygen mask. The wound care nurse was consulted and orders given but no new problem or goals were added. In hospice record review #4 the plan of care was not updated to include a patient fall, and subsequent facial laceration. This was discussed with the RN assisting with record review.

Observed in Patient Home. In 1 of 4 home visits conducted, it was noted in hospice home visit #2 that the hospice aide did not follow policy for hand hygiene. For example, the aide was observed washing her hands in the bathroom sink using the patient's bar soap and drying her hands with a hand towel that was hanging in the bathroom. This was observed twice during the visit. Additionally, she used the hand towel in one instance to turn off the faucet and then continued drying her hands with the towel. This was observed by the interim hospice director present on the visit. Observed in Tracer Visit. In 1 of 2 home visits conducted, where equipment was used during the visit it was noted that the nurse in hospice home visit #3 did not perform cleaning of equipment per agency policy. For example, she was observed cleaning the blood pressure cuff, thermometer, stethoscope with Sani Cloth which she wrapped around the items and placed them back onto the dirty barrier. After three minutes she was observed placing them back onto the clean barrier however her tablet was on the clean barrier and the equipment touched the tablet straps. Additionally, the used gloves to clean the equipment and did not change gloves when moving the cleaned equipment. This was observed by the hospice interim director.

Observed in Data Session. During the data session it was noted that for the hospice risk assessment the previous surveillance data had not been considered. For example, the hospice logs indicated that in the prior year Urinary Tract Infections and Respiratory infections were reported however neither of these were considered when assessing risk. This was discussed with the current and previous interim hospice directors and the infection prevention nurse.

Observed in Record Review. In 4 of 16 patient records reviewed, it was noted in review of record for hospice home visit #1 the aide plan of care did not contain any information regarding how the aide was to manage a large dressing to the right upper arm while showering the patient. In review of record for hospice home visit #4 it was noted that the aide plan of care did not include the need for oxygen to remain on the patient during shower. In review of record for hospice home visit #2 it was noted that the aide plan of care did not include any management of a buttock dressing. In review of hospice record review #9 it was noted that the aide plan of care did not include any management of a heel wound. Discussed this with the hospice RN assisting with record review and interim hospice director.

Observed in HR File Review. In 4 of 10 HR files reviewed, it was noted that the following competencies had not been assessed since 2018 as follows: Medical Director and alternate Medical Director, Music therapist and Massage therapist. This was confirmed by both the current and previous interim hospice director.

Observed in Record Review. In 1 of 2 patient records reviewed, for live discharges it was noted in hospice discharged record #2 for a patient who had revoked hospice care, there was no documentation that the discharge summary was sent to the attending physician. This was confirmed by the RN assisting with record review.

Observed in Record Review. In 8 of 8 patient records reviewed, where the patient resided in a Skilled Nursing Facility it was noted that the plan of care did not specifically identify which provider is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. This was noted in hospice record review #1,3, 4, 6, 8, 9 and 10 as well as record review for home visit #3. This was discussed with the RN assisting with record review and the hospice interim director.

Observed in Record Review. In 1 of 16 patient records reviewed, for hospice home visit #3 where the patient resided in a Skilled Nursing Facility, the facility record did not contain the physician certification of terminal illness. This was observed by the interim hospice director present on the visit.