Summit Hospice

“Upon patient record review, 4 of 15 (Patient #4, #6, #8, #9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #4: The medication profile indicates Hydrocortisone 2.5% cream, apply topically every 6 hours as needed to the affected area for itching. There is no evidence the order indicated where to apply the medication. Patient #6: The medication profile indicates Debrox 6.5%, 5-10 drops 2 times a day as needed. During the home visit a medication reconciliation was completed this medication was not present on the facility MAR. Patient #8: The medication profile indicates lidocaine 4% topical patch to be applied to affected area of pain. There is no evidence the order indicated where to apply the topical pain patch. Patient #9: The Facility MAR contained Tramadol 100 mg 1 tablet 2 times a day. The hospice medication profile also contained Tramadol 100mg with inconsistent instructions on the frequency to which the medication was to be administered. The facility MAR contained Ammonium lactate 12% lotion to apply to feet and legs every other day for dryness and was not present on the hospice medication profile.”

“Upon patient record review, 4 of 15 (Patient #3, #4, #6, #15) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #3: Medication profile indicated the patient is on cardiac medication for hypertension and anxiety medication. There was not evidence the plan of care reflected the patients/family goal and hospice interventions based on the problems identified. Patient #4: Medication profile indicated the patient takes scheduled anxiety medication and scheduled and prn medication for constipation. There was not evidence the plan of care reflected the patient/family goals and hospice interventions based on the problems identified. Patient #6: Medication profile indicated the patient is on medications for constipation. There was not evidence the plan of care reflected the patient/family goals and hospice interventions based on the problems identified. Patient #15: Record indicates patient is on a blood thinner. There was not evidence the plan of care reflected the patient/family goals and hospice interventions based on the problems identified to monitor safety and effectiveness of this therapy.”

“Upon patient record review, 3 of 15 (Patient #4, #8, #9) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #4: The record indicated Hydrocortisone 2.5% cream to apply topically every 6 hours prn to affected area for itching every 6 hours, the order did not indicate where to apply the cream. Patient #8: The record indicated an order for lidocaine 4% topical patch to apply to affected area of pain, the order did not indicate where to apply the pain patch. Patient #9: The facility MAR contained Ammonium Lactate lotion 12%. There is no evidence of an order in the hospice record. Also, Tramadol 100 mg, 1 tablet 2 times a day was present on the facility MAR and contained inconsistent instructions noted in the hospice record.”

“Upon patient record review, 2 of 15 (Patient #1, #15) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1: Documentation is noted in the medical record patient is a fall risk and has a cane available in the home for mobility. There was no evidence the aide care plan was updated to utilize this equipment during ambulation for patient safety. Patient #15: Documentation in the record indicates the patient becomes severely dyspneic with minimal activity, utilizes a wheelchair for mobility and has an active wound on coccyx with adhesive dressing in place. There was no evidence the aide care plan was updated to include oxygen or instructions on utilizing oxygen during cares, to utilize a Wheelchair for mobility or the location of the wound and if dressing was soiled or became wet or dislodged to notify the RNCM.”