Every finding on record at St. Marie's

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 2 of 14 (14%) clinical records with aide services ordered reviewed revealed that the agency did not ensure that all patient instructions were included in the aide care plan. Clinical Record 2: The initial RN assessment dated 01/26/2024 read in part "Patient has a 2.2cm x 2.5cm wound to the coccyx". The aide care plan dated 01/26/2024 did not include any instructions to the aide related to the wound. Clinical Record 14: The nursing visit note dated 10/19/2023 read in part "Patient has a new wound to the coccyx". The aide care plan dated 10/19/2023 did not include any instructions to the aide related to the wound. In an interview on 03/13/2024, the Director of Nursing reviewed the records and stated "There are no instructions on the aide care plan regarding the wounds".

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed of deceased patients it was revealed that the agency did not ensure that the disposal of controlled medications was documented. Document 1: Agency Policy H:2-059.1 dated 1/2/2019 titled Home Use and Disposal of Controlled Substances, read in part, "When a hospice patient no longer has a need for a controlled substance, the nurse case manager will instruct the patient and family/caregiver to dispose of them". Clinical Record 14: The record revealed a nursing death visit note dated 12/15/2023. The medication profile dated 12/09/2023 read in part "Morphine 20mg/ml concentrate, give 10mg every 2 hours as needed for pain". The record lacked evidence of the nurse instructing the caregiver on disposal of the morphine. In an interview on 03/14/2024, the Director of Nursing reviewed the record and stated "I am surprised that the nurse forgot to document the instruction on drug disposal. That should have been in the death note."