24/7 Care at Home - Hospice

“Upon patient record review, 1 of 14 (Patient #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 10:The patients plan of care includes an order for O2 at 2-5 LPM via NC PRN for shortness of breath. There is no evidence that oxygen is present on the medication profile.”

“Upon patient record review, 2 of 14 (Patient #3,#6) 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:The patient medical record includes nursing documentation upon admission of the presence of a 16 french foley catheter due to obstruction and patients inability to void. There is no evidence of problems, goals and interventions related to genitourinary issues and management. Patient 6:Upon admission, there is nursing documentation that the patient had a toe amputation requiring continued wound care. There is no evidence of problems, goals and interventions on the patients plan of care related to skin/integumentary issues and management.”

“Upon patient record review, 2 of 14 (Patient #4,#8) 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 medical record contains documentation by the nurse of wounds x 3 present upon admission. The plan of care includes an order for care to L heel and R Heels to cleanse with normal saline cleaner, pat dry, apply betadine, cover with non adherent dressing, secure with kerlex and tape, 3 times per week and when soiled. There is no indication within the order of whom is to perform wound care. There is an order for treatment of wound to sacrum to clean with normal saline, pat dry, apply collagen particles and cover with bordered foam dressing, 3 times per week and when soiled. There is no indication of who is to perform wound care. Patient 8: The plan of care includes an order obtained on 12/16/23 for wound care post fall due to an abrasion to patients forehead. The wound care order included placement of steri-strips over abrasion, apply antibiotic ointment and cover with dry dressing until healed. There is no evidence within the order of a frequency for treatment and no indication of whom is to complete wound care.”

“Upon patient record review, 1 of 14 (Patient #5) 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 5:The medical record includes nursing documentation upon admission of oxygen at 2-5 LPM via NC PRN for shortness of breath, an order for albuterol and the presence of a 16 fr. foley catheter. There is no evidence of oxygen equipment and supplies, catheter supplies, or nebulizer equipment and supplies on the DME/supplies list.”

“Upon patient record review, 2 of 14 (Patient #2,#9) 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 medical record contains nursing documentation of the patient being at risk for falls based on the initial comprehensive assessment. The Aide plan of care did not include fall precautions. Patient 9:The aide plan of care includes the task of dressing the patient. There is no frequency noted for completion of the assigned task.”

“Upon patient record review 1 of 14 (Patient #1) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 1: The initial plan of care includes an aide frequency of 2 visits per week effective 12/15/23. There is no evidence of visits being completed the week of 12/15/23 and no documentation of missed visits.”