Every finding on record at Scott & White Memorial Hospital

Observed in Record Review. In 1 of 10 patient records reviewed, the hospice plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the scope of the services necessary to meet the patient's and family's needs. In HV#3, the RN and family caregiver confirmed the hospice aide was providing a shower bath, personal care, and assistance with transfer/ambulation for the patient. In review of the record, it was noted there was no documented plan of care for the hospice aide services that were initiated two (2) weeks prior. This was reveiwed and confirmed with the Administrator/Manager.

Observed in Record Review. In 5 of 10 patient records reviewed, the organization did not include all services needed for the palliation and management of the terminal illness and related conditions, including medications and treatment necessary to meet the patient's needs. In review of the records for HV#1, HV#2, RR#2, and RR#7, it was noted the patient was on multiple prn medications for pain, with no clear indications documented for use (which pain medication to take when). It was also noted in review of the medication profile for HV#2, there was no order in the patient's plan of care for the Miralax the skilled nurse instructed the patient to continue to take daily. In RR#4, there was a documented order in the hospice plan of care to place foley catheter, with no further order detail regarding the indwelling urinary catheter size, balloon, drainage, frequency of changes, and/or irrigations. This was reveiwed and confirmed with the Administrator/Manager.

Observed in Patient Home. In 1 of 3 home visits conducted, the organization did not implement its planned infection prevention and control activities by taking precautions in response to the ways infections spread within the organization's service setting and community. During HV#1, the hospice aide placed soil linen, pads, and used/soiled gloves on the floor, then placed the dirty pads/gloves on an incontinence pad placed on floor. Upon arrival to the home, the hospice RN did provide the aide with a plastic trash bag. While providing the bed bath and patient care to the incontinent patient, the aide also did not perform hand hygiene prior to changing gloves. This was reviewed with the Hospice Manager/Administrator.

Observed in Record Review. In 2 of 8 hospice aide patient records reviewed, the organization did not provide care, treatment, or services in accordance with orders as required by law/regulation. The hospice aide did not provide services ordered by the physician in the plan of care. In HV#2, the aide did document providing a shower, but the plan of care did not specify a shower for the patient. In HV#3, the RN confirmed the aide was assisting the patient with a shower and personal care, but had not developed a written plan of care for the aide. Upon review of the record, the hospice aide documented providing a shower bath and personal care to the patient for two (2) weeks without an outlined care plan. This was reviewed and confirmed with the Administrator/Manager.

Observed in HR File Review. In 1 of 9 HR files reviewed, staff competence was not initially assessed/documented as part of orientation. In HR#1, it was noted the Hospice Medical Director, providing clinical/medical services as a member of the interdisciplinary team, did not have initial clinical competencies documented as part of orientation with the System Hospice Medical Director. This was reviewed and confirmed with the Administrator/Manager.