HospitalInspections.org

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Based on interview, record review, and review of hospital policies, the hospital failed to ensure that the plan of care for terminally ill patients included providing oral care, as demonstrated by the records of 4 of 5 patients reviewed (Patients #1, #2, #3, #4).

Failure to provide oral care for terminally ill patients risk development of mouth ulcerations due to excessive dryness, which can result in pain and discomfort during the dying process.

Findings included:

1. Review of the hospital's policy titled, "Terminally Ill Patient - Guidelines for Care," Policy #T-42a, reviewed 05/25/19, showed that hospital caregivers would "develop care plans that guide appropriate pain control, hygiene measures, and positioning.".

2. On 08/21/19 at 2:30 PM during an interview with the investigator, the hospital's Director of Nursing (Staff #1) stated that the nurses were directed to follow the Lippencott Procedure "Dying Patient Care" when providing care for terminally ill patients.

3. Review of the "Dying Patient Care" procedure showed the procedure directed nursing staff to provide oral care frequently, taking care to moisturize the oral mucosa and lips as needed to provide comfort.

4. On 08/21/19, the investigator reviewed the medical records of 5 terminally ill patients. This review showed the following:

a. Patient #1 was a 71 year-old patient who was admitted to the hospital on 05/22/19 for treatment of sepsis secondary to acute cystitis. On 05/23/19, the patient was determined to be terminally ill. Orders in the patient's record included "Perform oral hygiene - Oral care every two hours if possible and as needed. Keep lips moist. Nurse may teach family oral care." Review of the patient's plan of care revealed the plan did not include oral care. The patient's record did not contain evidence that oral care was offered or provided to the patient during her hospital stay. The patient was discharged to another hospital on 05/24/19.

b. Patient #2 was a 102 year-old patient who was admitted to the hospital on 07/31/19 for treatment of sepsis and dehydration. On 07/31/19, the patient was determined to be terminally ill. Orders in the patient's record included "Perform oral hygiene - Oral care every two hours if possible and as needed. Keep lips moist. Nurse may teach family oral care." The orders also included an order for artificial saliva drops to keep the patient's mouth moist five times a day as needed. Review of the patient's plan of care revealed the plan did not include oral care. The patient's record did not contain evidence that oral care and artificial saliva was offered or provided to the patient during her hospital stay. The patient died on 08/02/19.

c. Patient #3 was an 80 year-old patient who was admitted to the hospital on 06/21/19 for treatment of sepsis and an epidural abcess. On 06/28/19, the patient was determined to be terminally ill. Orders in the patient's record included "Perform oral hygiene - Oral care every two hours if possible and as needed. Keep lips moist. Nurse may teach family oral care." Review of the patient's plan of care revealed the plan did not include oral care. The patient's record did not contain evidence that oral care was provided after 06/26/19 at 8:00 AM. The patient was discharged to hospice care on 06/28/19.

d. Patient #4 was a 76 year-old patient who was admitted to the hospital on 06/21/19 for treatment of sepsis. On 06/21/19, the patient was determined to be terminally ill. Orders in the patient's record included "Perform oral hygiene - Oral care every two hours if possible and as needed. Keep lips moist. Nurse may teach family oral care." The orders also included an order for artificial saliva drops to keep the patient's mouth moist five times a day as needed. Review of the patient's plan of care revealed the plan did not include oral care. The patient's record did not contain evidence that oral care was provided after 06/22/19 at 12:00 AM or that the artificial saliva was administered to the patient during her hospital stay. The patient died on 06/24/19.

5. On 08/21/19 at 4:30 PM during an interview with the investigator, the Director of Nursing (Staff #1) and the Accreditation and Regulatory Affairs Manager (Staff #2) confirmed there was no evidence in the medical records that oral care had been provided for the four patients above, and that the patients' plan for care did not include oral care.
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