24/7 Care at Home - Hospice

“Upon patient record review, 5 of 14 (Patient #1, #2, #3, #8, #10) 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 #1:The medication profile indicates patient to take nitroglycerin for chest pain. There was no evidence noted on the medication profile of the maximum dose or when to notify the physician. The medication profile contains inconsistencies on the quantity and frequency of Imodium. Order indicate patient may take Imodium I tablet for diarrhea. Instructions state to take 2 tablets for diarrhea with no additional instructions if the symptom persists. The medical record indicated the patient has utilized oxygen therapy as needed since admission. Unable to locate the delivery method on the medication profile on how the oxygen is to be administered. Patient #2: The medication profile indicates latanoprost ophthalmic solution is to be administered 1 drop daily at bedtime. The medication profile does not define which eye or eye(s) for administration. Patient #3: The medication profile contains a duplicate oxygen therapy orders. On 12-14-25 order for oxygen 2-5 liters as needed for shortness of breath. On 4-2-26 order for oxygen 2-10 liters continuous. Patient #8: The medication profile reflects oxygen therapy to be administered at 2-5L continuous. Documented in the medical record patient utilizes oxygen at 2 liters as needed. No evidence of this on medication profile. Patient #10: The medication profile is lacking instructions on reconstituting MiraLAX prior to administration.”

“Upon patient record review, 2 of 14 (Patient #2, #7) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #2: The patient was admitted on 2-1-26. The record indicated that the initial bereavement risk assessment was completed on 2-10-26, which is greater than the 5 day requirement. Patient #7: The patient was admitted on 11-23-25. The record indicated that the initial bereavement risk assessment was completed on 3-12-26, which is greater than the 5 day requirement.”

“Upon patient record review, 6 of 14 (Patient #1,#4,#5,#6,#7,#8) 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 #1: Medical record contained documentation of a wound noted since admission. There is no nursing problem statement, goals, interventions and progress towards outcomes related to impaired skin integrity. Patient #4: The medication profile indicates the patient is on a blood thinner. There was no evidence of a problem statement with goals, interventions and progress toward outcomes related to bleeding. Patient #5: RN documented in the medical record that patient is a fall risk. There was no evidence of a problem statement with goals, interventions and progress toward outcomes related to fall safety Patient #6: The medical record indicates the patient has endocrine insufficiencies and pain. There is no evidence of a problem statements, goals and interventions for the management of the endocrine system or pain. Patient #7: The medication profile indicates the patient is on a blood thinner. There was no evidence of a problem statement with goals, interventions and progress toward outcomes related to bleeding. Patient #8: Patient admitted on 3-16-26 as NPO. The medication profile instructed that all medications and nutrition to be administered via the patients gastrostomy tube. The current problems, goals and interventions were not individualized to reflect the patient’s NPO status.”

“Upon patient record review, 4 of 14 (Patient #1,#2,#8,#10) 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 #1: The medication order for nitroglycerine did not indicate when to notify the physician. There was no evidence noted in the physician order dated on 5-6-26 as to the location of the wound or the frequency of the dressing changes to be performed. There was no evidence noted in the physicians order for the delivery method for oxygen therapy. The medication order did not contain instructions on maximum dose and frequency of Imodium if the initial dose was ineffective. There is documentation in the medical record that for wound to the patients hand. Unable to identify the location of the wound or the frequency of the dressing changes to be performed. Patient #2: There was no evidence in the physician order indicating which eye or eye(s) to administer the latanoprost ophthalmic solution drops. Patient #8: There was no evidence a physician order was obtained to update the current oxygen order from 2-5 liters continuous to 2 liters as needed. There was no evidence in the physician wound care order on 5-12-26 as to the location of the wound or the frequency of dressing changes. Patient #10: The medication order for MiraLAX did not include the quantity of liquid required to reconstitute prior to administration.”

“Upon patient record review, 5 of 14 (Patient #1,#2,#5,#9,#10) 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 equipment and supply needs. Patient #1: The RN documented in the medical record the use of a walker and LAL mattress. No evidence of a order to place the equipment. Patient #2: The RN documented in the medical record the use of bedrails, Geri chair and a Hoyer lift. No evidence of a order to place the equipment. Patient #5: The RN documented in the medical record the patient had a shower chair, air mattress and walker. No evidence of an order to place the equipment. Patient #9: The RN documented in the medical record the patient uses a walker for ambulation. No evidence of an order to place the equipment. Patient #10: The RN documented in the medical record the patient uses a Geri chair at every visit per the aide care plan. No evidence of an order to place the equipment.”

“Upon patient record review, 3 of 14 (Patient #2,#7,#8) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #2: RN documented in the initial comprehensive assessment on 2-1-26 patient had a wound to right finger. The RN documented in the medical record on 4-17-26 the that the stage 2 wound was resolved. There was no evidence that plan of care was updated to remove the wound care goals and interventions. Patient #7: The RN documented in the medical record on 5-1-26 new wound care orders. There was no evidence that the plan of care had been updated to reflect the change in the wound status from stage 4 to stage 2 wound. Patient #8: The nurse documented in the medical record on 5-12-26 new orders received for a Stage 2 wound on buttocks. No evidence documented on the location or frequency of wound care.”

“Upon patient record review, 3 of 14 (Patient #2,#5,#8) 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 #2: The aide plan of care indicated the patient utilized oxygen; however, did not clarify if the patient was to wear continuous or as needed for shortness of breath. Patient #5: The aide plan of care lacked instructions to utilize a walker with all transfers and ambulation. Patient #8: The aide plan of care lacked instructions for oxygen safety, bathing instructions, and safety with a gastrostomy tube.”

“Upon patient client record review, 2 of 14 (Patient #3,#9) did not have evidence that each patient record contains Advance Directives.\ Patient #3: On 12-14-25 legal documents were signed to initiate hospice services by daughter and indicated the patient had an Advance Directive. Unable to locate the document in the medical record to support these findings at the time of survey. Patient #9: On 1-20-26 legal documents were signed to initiate hospice services by the son indicating the patient had an Advanced Directive. Unable to locate the document in the medical record to support these findings at the time of survey.”