Every finding on record at Sutter Visiting Nurse Association and 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, interview, and observation. In 11 of 14 (79%) clinical records reviewed of patients who received Hospice Aide services, the organization did not ensure that all written instructions were included in the aide care plan. Clinical Record 3: The patient elected hospice care on 02/24/2024. The plan of care dated 02/24/2024 ordered a continuous hydromorphone infusion via CADD Prizm Pump and continuous oxygen at 2-5 liters (L)/minute (min) per nasal cannula, titrated to the patient's comfort. The aide care plan dated 10/16/2024 did not provide the aide with instructions or precautions for the patient's continuous oxygen or the CADD Prizm Pump during patient care. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 4: The patient elected hospice care on 12/05/2023. The plan of care dated 12/05/2023 ordered oxygen 2-4L per nasal cannula for the patient’s comfort. The aide care plan dated 12/08/2023 did not provide the aide with instructions or precautions for the patient's oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 6: The patient elected hospice care on 07/19/2024. The plan of care dated 07/22/2024 ordered oxygen 2-5L per nasal cannula for the patient’s comfort. The aide care plan dated 07/22/2024 did not provide the aide with instructions or precautions for the patient's oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 10: The patient elected hospice care on 05/02/2023. The plan of care dated 10/23/2024 documented a right hip unstageable pressure ulcer requiring wound care dressing changes twice weekly. The aide care plan dated 12/20/2023 had not been updated to include instructions for the patient’s right hip wound dressing should the dressings become wet or dislodged during bathing. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 15: The patient elected hospice care on 08/28/2024. The plan of care dated 11/26/2024 documented a laceration to the left arm with wound care (effective 11/19/2024). The aide care plan dated 08/30/2024 had not been updated to include instructions for the patient’s left arm wound dressing should they become wet or dislodged during bathing. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 16: The patient elected hospice care on 08/13/2024. The plan of care dated 11/11/2024 ordered oxygen 2-5L/min per nasal cannula for the patient’s comfort. The aide care plan dated 09/30/2024 did not provide the aide with instructions or precautions for the patient's oxygen. Additionally, the aide care plan did not include instructions for the patient’s weeping and edematous lower extremities during personal care and bathing, which had been written in a physician's interim order, with instruction provided to facility staff on 12/04/2024. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 17: The patient elected hospice care on 11/02/2024. The plan of care dated 11/02/2024 ordered oxygen at 2L/min per nasal cannula to be used as needed for comfort. The aide care plan dated 11/05/2024 did not provide the aide with instructions or precautions for the patient's oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 18/Home Visit 1: The patient was admitted to hospice services on 01/11/2024. During the home visit with the Registered Nurse (RN) [Personnel Record 5] on 12/03/2024, the patient was observed to be dependent on supplemental oxygen. The plan of care effective 11/06/2024 ordered 2-4L per nasal cannula for the patient’s comfort. The aide care plan, last updated 01/12/2024, did not provide the aide with instructions or precautions for the patient's continuous oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 20/Home Visit 3: The patient was admitted to hospice services on 10/04/2024. During the home visit with the Hospice Aide (HHA) [Personnel Record 7] on 12/04/2024, a wound on the patient’s left arm, which was discovered by the HHA [Personnel Record 7] on 11/29/2024, was covered with dry gauze as ordered by the physician. The aide care plan, last updated 10/15/2024, had not been updated to include instructions for the patient’s left arm wound dressing should the dressing become wet or dislodged during bathing. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 21/Home Visit 4: The patient was admitted to hospice services on 03/14/2023. During the home visit with the Hospice Aide (HHA) [Personnel Record 8] on 12/04/2024, the patient was observed to be dependent on supplemental oxygen. The plan of care effective 11/03/2024 ordered 2-4L per nasal cannula for the patient’s comfort. The aide care plan, last updated 07/15/2024, did not provide the aide with instructions or precautions for the patient's continuous oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024. Clinical Record 22/Home Visit 5: The patient was admitted to hospice services on 01/29/2024. During the home visit with the Chaplain (CH) [Personnel Record 9] on 12/04/2024, the patient was observed to be dependent on supplemental oxygen. The plan of care dated 11/03/2024 ordered 2-4L per nasal cannula for the patient’s comfort. The aide care plan dated 10/16/2024 did not provide the aide with instructions or precautions for the patient's continuous oxygen. The findings were confirmed during a joint record review and interview with the Administrator, Director of Patient Care Services (DPCS), and Clinical Managers on 12/05/2024.