Acg Hospice - Andalusia

“Based on the review of medical records (MR), policy and procedure, observations, and interviews, it was determined the agency failed to ensure a current, accurate medication profile was available in the MR. This affected one of three home visits (HV), including HV # 2, and had the potential to negatively affect all patients served by the agency. Findings include: Policy: Medication ProfilePolicy Number: 2-004Purpose: To define the use of the medication profile in evaluating a patient’s medication regimen.Policy: Patients receiving medications... will have a current, accurate medication profile in the medical record. The medication profiles will be updated for each change to reflect current medications, and new and/or discontinued medications.Procedure: 1. Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen... 2. A drug regimen review will be performed at the time of initial and comprehensive assessment, when updates to the comprehensive assessment are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication... 3. During subsequent HVs, the medication profile will be used as a care planning and teaching guide to ensure the patient and family/caregiver, as well as other clinicians, understand the medication regimen... 5. Based on review of the medication profile... changes in the plan of care may be required... 7. Deviations from taking medications as ordered will be documented in the MR, and the physician... will be notified. HV # 2 was admitted to the agency on 5/28/25 with the primary diagnosis of Hypertensive Heart Disease with Heart Failure. A HV was conducted on 7/23/25 at 9:20 AM with Employee Identifier (EI) # 3, Hospice Aide, to observe care provided in the home. During the HV, the surveyor and the caregiver (CG), reviewed the Client Medication Report (CMR). The following discrepancies were observed:Allopurinol 300 milligram (mg) tablet, take 1 tablet by mouth (PO) daily, was available in the home and was listed as current on the CMR. The CG stated that HV # 2 has not taken the medication for “a couple of months.”Atorvastatin 80 mg tablet, take 1 tablet PO daily, was available in the home. The medication was listed as discontinued on the CMR but the CG stated HV # 2 still takes it daily. An interview was conducted on 7/24/25 at 12:11 PM with EI # 1, Manager of Regulatory Compliance and Accreditation, who confirmed the CMR was not current or accurate.”

“Based on medical record (MR) review, agency policy and procedure, and interview, it was determined the agency failed to provide education to the patient/caregiver (cg) for new medications ordered. This deficient practice affected Home Visit (HV) # 1, one of seven active records reviewed, and had the potential to affect all patients served by this hospice.Findings include: Policy: Medication ProfilePolicy Number: 2-004Purpose:To define the use of the medication profile in evaluating a patient’s medication regimen.Policy:Patients receiving medications... will have a current, accurate medication profile in the medical record. The medication profiles will be updated for each change to reflect current medications, and new and/or discontinued medications.Procedure: 1. Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen... 2. A drug regimen review will be performed... with the addition of a new medication... 3. During subsequent HVs, the medication profile will be used as a care planning and teaching guide to ensure the patient and family/caregiver, as well as other clinicians, understand the medication regimen. This includes but will not be limited to:...B. Using the medication profile to teach purpose of medication, dosages, routes, administration times, side effects, and contraindications. HV # 1 was admitted to the agency on 3/21/25 with a primary diagnosis of End Stage Heart Failure.Review of the Hospice Recertification and Plan of Care Update dated 5/5/25 for certification period 5/20/25 to 7/18/25 revealed the following orders:a. Effective 5/20/25, SN (Skilled Nurse) to visit one time a week for one week, two times a week for eight weeks.b. Hospice nurse to assess medication response and instruct on schedule, actions, purpose, side effects, compliance and need to report side effects to hospice staff.Review of physician orders revealed the following orders:Beginning 6/4/25, Lexapro 10 milligrams (mg), one tablet daily by mouth for depression and Buspar 15 mg, one tablet BID (twice daily) as needed for anxiety and depression.Beginning 6/23/25, Cipro 250 mg by mouth BID for seven days for UTI (urinary tract infection) symptoms.Review of SN visit notes dated 6/6/25 to 7/18/25 revealed no documentation the patient or cg were provided education on the new medications.The agency failed to provide education to the patient/cg on the new medications.An interview was conducted on 7/24/25 at 12:39 PM with Employee Identifier (EI) # 2, Director of Operational Support, who confirmed the agency failed to provide education to the patient or cg on the new medications.”

“Based on review of Medical Records (MR), agency policy and procedure, and staff interview it was determined the hospice staff failed to obtain physician orders for oxygen.This deficient practice affected MR # 6, one of ten MRs reviewed and had the potential to affect all patients served by this hospice.Findings Include: Hospice Policy: Verification of Physicians OrdersPolicy Number: 2-002Revised Date: NonePurpose: To ensure that accurate physician orders are obtained in accordance with applicable law and regulations. Policy: Orders will be obtained from a licensed physician for care and services to be provided to hospice patients. Procedure: …3. Orders will be documented by hospice in the electronic medical record… MR # 6 was admitted to hospice on 1/2/25 with primary diagnosis of End Stage Renal Disease.Review of the Skilled Nurse (SN) visit note report dated 1/15/25 revealed “…patient using oxygen at 2 Liters (L) majority of the time to relieve dyspnea …”Review of the SN visit note reports dated 1/17/25 and 1/18/25 revealed, on oxygen 2 L, documented under vital sign details. Review of the SN visit note report dated 1/19/25 SN narrative revealed, “…Only requires oxygen PRN…”Review of the Hospice IDG (Interdisciplinary Group) Comprehensive Assessment and Plan of Care Update Report dated 1/17/25 revealed no physician order for oxygen. There was no documentation oxygen was ordered by the physician.An interview was conducted on 7/24/25 at 12:19 PM with Employee Identifier (EI) # 2, Director of Operation Support, who confirmed staff failed to obtain a physician’s order for Oxygen.”

“Based on medical record (MR) review, Alabama Board of Nursing Administrative Code, agency policy and procedure, and interview, it was determined the the agency failed to ensure a physician pronounced the death of patients.This deficient practice affected four of five Bereavement MRs reviewed, including MR # 7, MR # 6, MR # 8 and MR # 5, and had the potential to negatively affect all patients admitted to this hospice.Findings include:Agency Policy: Death At HomePolicy Number: 2-035Revised Date: NonePurpose:To establish the process to follow when a patient dies.Policy:...Individual state and community regulations and practices will be followed....Note: Hospice should check specific state law regarding death at home and adapt policy to meet state law/statute.Procedure:...4. The nurse will notify the attending physician of the patient’s death. It will be the attending physician’s responsibility to pronounce death (depending on state regulations) ...Alabama Board of Nursing Administrative CodeChapter 610-X-6Standards of Nursing PracticeRevised: September 8, 2016610-X-6-.15 Telecommunication for Pronouncement of Patient DeathThe licensed nurse may receive pronouncement of a patient’s death from a physician via telecommunication. 4. MR # 5 was admitted to the agency on 6/8/25 with a primary diagnosis of Senile Degeneration of Brain, Not Elsewhere Classified. Review of the SN Visit Note dated 7/11/25 revealed the patient expired at 5:12 AM. There was no documentation the physician pronounced the patient’s death.An interview was conducted on 7/24/25 at 12:24 PM with EI # 2 who confirmed there was no documentation the physician pronounced the patient’s death. 2. MR # 6 was admitted to the agency on 1/2/25 with a primary diagnosis of End Stage Renal Disease. Review of the SN Visit Note dated 1/20/25 revealed the patient expired at 11:38 AM. There was no documentation the physician pronounced the patient’s death.An interview was conducted on 7/24/25 at 12:19 PM with EI # 2, Director of Operation Support, who confirmed there was no documentation the physician pronounced the patient’s death.3. MR # 8 was admitted to the agency on 3/29/22 with a primary diagnosis of Malignant Neoplasm of Colon Unspecified.Review of the SN Visit Note dated 10/21/24 revealed the patient expired at 11:04 PM. There was no documentation the physician pronounced the patient’s death.An interview was conducted on 7/24/25 at 12:34 PM with EI # 2, who confirmed there was no documentation the physician pronounced the patient’s death. 1. MR # 7 was admitted to the agency on 3/5/25 with a primary diagnosis of Malignant Neoplasm of Unspecified Part of Unspecified Bronchus or Lung. Review of the Skilled Nurse (SN) Visit Note dated 4/11/25 revealed the patient expired at 10:31 PM. There was no documentation the physician pronounced the patient’s death.An interview was conducted on 7/24/25 at 12:33 PM with Employee Identifier (EI) # 1, Manager of Regulatory Compliance and Accreditation, who confirmed there was no documentation the physician pronounced the patient’s death.”