Every finding on record at Traditions Hospice of Chickasha, LLC

Observed in Record Review. In 1 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that the comprehensive assessment was not completed with five calendar days of the election of hospice care. For RRNHV#1, on day five after admission, the Chaplain had documentation that he could not reach the family to schedule a visit and therefore had a missed visit. There was no other documentation to show that he attempted further contact. The spiritual assessment was completed more that thirty days after admission. Additionally, the Social Worker completed her visit six days after the admission. There was no documentation in the electronic medical record to indicate why her visit was late. Finding was verified by the Branch Director and the Clinical Team Leader.

Observed in Record Review. In 14 of 14 patient records reviewed, for active hospice patients the nurse surveyor noted that the goals were not consistently measurable. For example, “Patient exhibits reduction/relief of any cardiopulmonary problems,” and “Pain will be managed at a level acceptable to patient by end of certification period”. Additionally, goals were mostly the same from patient to patient with minimal individualization. There were no short-term goals at start of care to address issues of immediate needs such as understanding medication management, symptom management, pain management, or safety, most time frames for completion were at the end of certification period or had no time frames for completion at all. Findings were discussed with the Branch Director and Clinical Team Lead.

Observed in Record Review. In 2 of 14 patient records reviewed, for active patients, it was noted by the nurse surveyor that the plan of care did not include all needed services. For RRHV#2 and RRHV#3, there were no orders for the care of the patient’s foley catheter, to include the frequency of changing the catheter or the size of the catheter to be used. Finding was verified by the Branch Manager and the Clinical Team Leader.

Observed in Patient Home. In 3 of 4 home visits conducted, it was observed by the Nurse Surveyor that the organization did not implement the infection prevention and control activities it had planned per policy “Hand Hygiene – IC15 Policy and Procedure”. During RRHV#1 hospice aide used hand sanitizer and donned gloves. She then settled the patient on the commode in the bathroom and then gathered the patient’s clean clothes and towels and set up her shower. The hospice aide then assisted the patient to take off her clothes and get in the shower. She then assisted the patient to shower, dried her off and applied lotion to the patient’s legs. The hospice aide then assisted the patient into clean clothes. At no point did the hospice aide hand sanitize or change gloves per policy during this time. The Branch Director was present the visit and observed the break in policy. During RRHV#2 the medical social worker applied hand sanitizer per the facilities wall mounted hand sanitizing dispenser. She then rubbed her hands together briefly then began shaking her hands to dry them more quickly. During RRHV#3 the skilled nurse had two missed opportunities to perform hand hygiene per policy when she removed gloves and donned new ones. The Clinical Team Lead was present during the visits and observed the breaks in policy.

Observed in Tracer Activities. It was noted by the nurse surveyor upon review of the Volunteer Services Program that the organization had one pet therapy volunteer, however, the organization had not defined the role of pet therapy volunteers. Finding was verified by the Volunteer Coordinator and the Branch Director.

Observed in Record Review. In 1 of 14 patient records reviewed, for active patients it was noted by the nurse surveyor that the medication profile was inaccurate. During RRHV#3 the skilled nurse asked the patient’s wife if she were still using Benadryl cream on the rash that had developed on the patient’s back. The cream was still being used; however, the Benadryl cream had not been added to the medication profile. Finding was verified by the Clinical Team Lead..

Observed in Record Review. In 2 of 2 patient records reviewed, for live discharge, it was noted by the nurse surveyor that a hospice discharge summary was not sent to the attending physician for RRDC#1 (revocation) and RRDC#2 (discharge for extended prognosis). Finding was verified by the Branch Director.