Every finding on record at Old Colony Hospice

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 9 of 17 (53%) clinical records with aide services provided, it was revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 1: The record revealed a physician's order dated 05/15/2024 that included wound care with wound dressings to wounds on the left buttock and right foot. The aide care plan dated 05/15/2024 lacked instructions regarding the wound dressings on the left buttock and right foot. Clinical Record 4: The record revealed a physician's order dated 10/10/2023 that read in part "Oxygen 1-4 liters via nasal cannula continuously.". The aide care plan dated 10/10/2023 lacked instructions regarding the oxygen. Clinical Record 6: The record revealed a physician's order dated 12/29/2022 that read in part "Oxygen 1-4 liters via nasal cannula continuously.". The aide care plan dated 12/29/2022 lacked instructions regarding the oxygen. Clinical Record 7: The record revealed a physician's order dated 04/24/2024 that included wound care with a wound dressing to a wound on the left foot. The aide care plan dated 04/24/2024 lacked instructions regarding the wound dressing on the left foot. Clinical Record 10: The record revealed a physician's order dated 07/11/2024 that read in part "Oxygen 3-5 liters via nasal cannula continuously.". The aide care plan dated 07/11/2024 lacked instructions regarding the oxygen. Clinical Record 13: The record revealed a physician's order dated 07/31/2024 that included wound care with wound dressing to a wound on the left foot. The aide care plan dated 08/01/2024 lacked instructions regarding the wound dressing on the left foot. Clinical Record 15: The record revealed a physician's order dated 06/10/2024 that included wound care with a wound dressing to a suprapubic catheter site. The aide care plan dated 06/10/2024 lacked instructions related to the wound dressing on the suprapubic catheter site. Clinical Record 16: The record revealed a physician's order dated 06/24/2024 that read in part "Oxygen 5-10 liters continuously via nasal cannula.". The aide care plan dated 06/24/2024 lacked instructions regarding the oxygen. Clinical Record 21: The record revealed a physician's order dated 06/16/2024 that included wound care with a wound dressing to a wound on the left heel. The aide care plan dated 06/16/2024 lacked instructions regarding the wound dressing to the left heel. In an interview on 08/21/2024, the Director of Nursing reviewed the records, confirmed the findings and stated, "There are no instructions for the wound dressings or oxygen in these aide care plans."

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 17 (6%) clinical records with aide services provided, it was revealed that the agency did not ensure that aide supervisory visits were completed no less frequently than every 14 days. Clinical Record 20: The election of hospice benefits was 11/01/2023. A physician's order dated 11/01/2023 read in part "Aide services 2x/week." The first aide supervisory visit was dated 11/02/2023. The next aide supervisory visit was dated 11/27/2023, 25 days later. In an interview on 08/22/2024, the Director of Nursing reviewed the record, confirmed the finding and stated, "There are no aide supervisory visits between 11/02/2023 and 11/27/2023."

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 23 (9%) clinical records reviewed it was revealed that the agency did not ensure all physician's orders were included in the patient's clinical record. Clinical Record 3: The record revealed a physician's order dated 06/28/2024 that read "Place 16Fr, 10ml Foley catheter.". The record lacked a physician's order regarding when to change the Foley catheter. Clinical Record 15: The record revealed an initial nursing assessment dated 06/10/2024 that read in part, "Patient is on BiPAP continuously.". The record also revealed a physician's order dated 06/10/2024 for the patient's BiPAP settings. The record lacked a physician's order for the frequency of use for the BiPAP. In an interview on 08/21/2024, the Director of Nursing reviewed the records, confirmed the findings and stated, "There are no specific orders in the chart for changing the Foley catheter or when BiPAP is to be used."