Guardian Angel Hospice, Inc.

“Upon patient record review, 1 of 14 (Patient #2) 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 2: On the medication profile there is an order for Acetaminophen 1000mg/30ml, 10ml twice daily and Acetaminophen 650mg rectal suppository every 4 hours as needed. There is not a daily limit for Acetaminophen. Corrected on site.”

“Upon patient record review, 3 of 14 (Patient #1,4,5) 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: On the comprehensive assessment the RN identifies the patient is at high risk for skin breakdown, there is not a risk of skin breakdown on the plan of care with goals and interventions. Corrected on site. Patient 4: On the comprehensive assessment the RN identifies the patient is using a walker to ambulate, there is not a risk of falls on the plan of care with goals and interventions. There is an order for Eliquis in the patient record, there is not a risk for bleeding on the plan of care with goals and interventions. Corrected on site. Patient 5: In the patient record there is an order for Aspirin 81mg daily, there is not a risk of bleeding on the plan of care with goals and interventions. Corrected on site.”

“Upon observation and home visits, 3 of 3 (Patient #1,2,3) there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 1,2,3: During home visits the skilled nurse did not wash hands before returning the cleaned blood pressure cuff, thermometer, and pulse oximeter to the clean bag. The skilled nurse wiped the equipment and continued to have dirty gloves on and returned the equipment to the clean bag. The LVN did not follow the bag policy procedure as outlined in the hospice’s policy and procedures.”

“Upon patient record review, 5 of 14 (Patient #1,4,6,7,9) 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 1: On the aide plan of care there is an order to turn and reposition, record bowel movements, feeding assistance, change patient linens, these orders do not contain a frequency. Patient 4: On the aide plan of care there is an order to record bowel movements, change patients linens, these orders do not contain a frequency. Corrected on site. Patient 6: On the aide plan of care there is an order to record bowel movements, change patients linens, these orders do not contain a frequency. Corrected on site. Patient 7: On the aide plan of care there is an order to turn and reposition, record bowel movements, encourage fluids as tolerated if not contradicted, change patient linens, there is not a frequency for these orders. Patient 9: On the aide plan of care there is an order for record bowel movements, change patient linens, there is not a frequency for these orders.”