Every finding on record at Traditions Hospice of Galveston, LLC

Observed in Patient Home. In 1 of 3 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”. For example, during RRHV#1 the hospice nurse hand sanitized and donned gloves. She then assessed the patient’s buttocks wound. She did not take off the Tegaderm dressing, but touched the dressing and area around it, she then assessed the gluteal folds and noted that the patient was soiled. She then left the bedside (without removing or changing her gloves) and began to search around for peri wipes. She went in the patient’s nightstand drawer, and a bag of supplies until she found the wipes, she then cleaned the patient, changed her diaper and under pad and then removed her gloves and washed her hands. Finding was discussed with the Branch Director after the visit. Observed in Patient Home. In 1 of 3 home visits conducted, it was observed by the nurse surveyor that the nurse did not clean her equipment per agency policy, “For RRHV#1 the hospice nurse took her equipment (BP cuff, stethoscope, thermometer, pulse oximeter, tape measure) out of her bag and put it on a barrier on the patient’s bedside table. She then took the patient’s vital signs, as she used each piece of equipment, she placed each piece of dirty equipment directly next to/on top of the clean equipment. When she cleaned the equipment, she cleaned each piece and put it right back on the barrier where the dirty equipment had been to allow it to dry. Finding was discussed with the Branch Director after the visit.

Observed in Record Review. In 1 of 14 patient records reviewed, it was noted by the nurse surveyor that the hospice aide care plans did not contain all the necessary or current information. For RRHV#3, the patient’s initial care plan indicated that he was to have a shower. At some point during the certification period the patient decided he preferred to be bathed while standing up at the sink in his bathroom, however, the Hospice Aide Careplan had not been updated to reflect this change. In addition, the patient had PRN oxygen ordered. However, the care plan did not address what the aide should do regarding the oxygen while performing the patient’s activities of daily living if the patient should be using oxygen during the visit. There was no mention of Oxygen safety precautions on the care plan. Additionally, there were no instructions regarding when the aide should notify the nurse. Findings were discussed with the Branch Director.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that the hospice aide did not provide care according to the hospice aide plan of care. for RRHV#2, the hospice aide care plan instructed the hospice aide to provide a shower. However, during the home visit it was noted that the patient preferred to have the aide bathe him while he stood in front of the bathroom sink which is what she did. Findings were verified by the Branch Director who was present during the visit.

Observed in Patient Home. In 1 of 3 home visits conducted, it was noted by the nurse surveyor that for RRHV#3, the individualized disaster plan in the patient’s home folder was blank. After discussion with the Branch Director, it was noted that a copy of the form was filled out and returned to the office to be put in the EMR. A copy for patient/family education and reference had not been returned to the home.