Every finding on record at Traditions Hospice of Round Rock, LLC

Observed in Record Review. In several records where the interdisciplinary group met more than twice, the organization did not update comprehensive assessments to reflect changes that had occurred since the initial assessment. The surveyor found that not all interdisciplinary group notes included documentation of on-going patient decline, progress toward goals, and plans for the next two weeks. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead.

Observed in Record Review. In 5 of 11 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions. In the record of HV#1 there was no documented reason for prn visits. Oxygen was ordered at two to seven liters per minute continuously per nasal cannula without parameters for liter flow rates or documentation of education regarding the correct liter setting to use for symptom severity. In the record of HV#2 it was documented that the patient had a wound to the left lateral ankle and an itchy rash on the back. These were not addressed on the plan of care. In the record of HV#3 oxygen was ordered at two to five liters per minute per nasal cannula as needed for shortness of breath also without parameters for liter flow rates or documentation of education regarding the correct liter setting to use for symptom severity. In that same record it was also documented that Lorazepam was effectively treating the patient’s anxiety, but there was no order on the plan of care. In the record of RR#1 it was documented that the patient tripped on his oxygen tubing, fell, and sustained a small laceration above his right eye. This was not addressed in the plan of care. In the record of RR#2 it was documented that the patient was on continuous high flow oxygen at seven liters per minute but there was no order on the plan of care. Orders were obtained for HV#3 and RR#2 during the survey. All of this was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead.

Observed in Patient Home. The organization did not utilize standard precautions, including the use of personal protective equipment, to reduce the risk of infection. At HV#1 the surveyor observed that an RN did not remove gloves worn throughout the visit and perform hand hygiene prior to picking up her cell phone to enter information into the electronic medical record. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead. Observed in Patient Home. The organization did not implement the infection prevention and control activities it had planned. During HV#2 the surveyor observed a CNA perform hand hygiene at the beginning of her visit. After washing hands, she used a paper towel to dry them, turned off the water using the same towel, and then wiped her hands again. In addition, when she doffed gloves, she twice failed to perform hand hygiene before donning clean gloves. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead. Observed in Patient Home. The organization did not implement the infection prevention and control activities it had planned. At HV#1 the surveyor observed that an RN did not close her visit bag after removing supplies and equipment as required in the Bag Technique policy IC.60. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead.

Observed in Record Review. There were no instructions in the hospice aide plan of care to not remove oxygen during bathing for a patient using oxygen continuously. This was noted in the record of HV#1 and was corrected immediately when brought to the attention of the leadership team.

Observed in Record Review. In the record of HV#1 the surveyor found that the patient refused a shower, and the aide did not document that a registered nurse was notified. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead.

Observed in Patient Home. At HV#3 the surveyor observed that two oxygen tanks were standing unsecured. Later, while reviewing the patient’s record, it was noted that there was no documentation that education on safe use of durable medical equipment was provided. This was reviewed with the Regional Director of Operations, Administrator and Clinical Team Lead.