Every finding on record at Visiting Nurse Services of Iowa

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: Hand hygiene. This standard was not met as evidence by document review, observation, and interview. In 2 of 3 (67%) home visit observations the hospice did not ensure the hand hygiene policy was followed. Agency policy and procedure titled: “Hand Hygiene” (no date), stated in relevant part… “perform hand hygiene as follows: Remove jewelry on the hands and arms, (eg ring, watch), during hand hygiene per the organization’s practice. Do not leave jewelry on the patient’s sink, counters, or tables. If rings are replaced after hand hygiene, perform hand hygiene again.” Records #57727 and #13656: During home visit observations, for both patients conducted on 6/29/22, the Registered Nurse (staff #38240) removed hand sanitizer from the outer pocket of the nursing bag and sanitized her hands. The nurse was wearing a ring and a watch. She did not remove her jewelry each time she performed hand hygiene per agency policy. During interview with the Administrator (#11584), on 6/29/22, the policy was confirmed as the most current policy, and it was confirmed that the clinicians were not to wear jewelry or to remove for hand hygiene, including when using hand sanitizer. The policy referenced the World Health Organization (WHO), and the Center for Disease Control (CDC), and stated the information was retrieved on February 18, 2022.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: a copy of the hospice discharge summary. This standard was not met as evidenced by record review and interview. In 1 of 1 (100%) clinical record, in which a live discharge occurred, the agency did not ensure that the discharge summary was provided to the attending physician. Record #83507 (Election of benefit: 1/25/22): Documentation in the clinical record revealed that the patient was discharged on 4/20/22 due to stability. A discharge summary was present, but the record did not contain any documentation that it was provided to the attending physician. During an interview, on 6/29/22, the Administrator (#11584) reported that they had previously identified that the clinicians responsible for contacting the attending physicians and sending the discharge summaries had not been documenting this in the records and a new process had been implemented. She confirmed that the documentation was not present for this record.