Above and Beyond Hospice Care

“Upon patient record review 3 of 14 (Patient #1,6,8) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #1: No evidence that the psychosocial assessment was complete within 5 days after election of hospice. Patient was admitted on 09/05/2023. Completed on 09/11/2023. Patient #6: No evidence that the spiritual assessment was complete within 5 days after election of hospice. Patient was admitted on 02/17/2024. Completed on 02/28/2023. Patient #8: No evidence that the psychosocial assessment was complete within 5 days after election of hospice. Patient was admitted on 03/06/2024. Completed on 03/12/2024.”

“Upon patient record review, 8 of 14 (Patient #1,3,4,5,6,8,9,10) 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 #1,3,4,5,6,8,9,10: Treatment order for oxygen 2LPM via nasal cannula PRN and titrate up to 5L/min for shortness of breath/respiratory discomfort. There was not evidence that oxygen was on the active medication profile.”

“Upon patient record review, 7 of 10 (Patient #2,3,4,6,8,9,10) 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 #2,3,4,6,8,9,10: There was no evidence that an initial bereavement risk assessment was completed. Only the bereavement screening completed during RN admission assessment for all patients listed.”

“Upon patient record review, 1 of 14 (Patient #1) 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: Patient admitted with secondary dx of seizures and currently takes Keppra for seizure prevention. No evidence that intervention and goals for seizures included in the current plan of care.”

“Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1,2,3,4,5,6,7,8,9,10: SW initial orders written as “Initial eval and PRN visits”. No evidence that a routine visit frequency was ordered nor was a quantity for the PRN visits ordered. Patient #7,10: SC initial orders written as “Initial eval and PRN visits”. No evidence that a routine visit frequency was ordered nor was a quantity for the PRN visits ordered.”

“Upon patient record review 4 of 14 (Patient #1,2,3,8) 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 aide plan of care has visit frequency as weekly effective on 09/05/2023. No evidence that those visit have occurred at the time of survey. No evidence that a physician order was placed to discontinue those visits or that those visits were declined by the patient/family. Patient #2: The aide plan of care has visit frequency as twice weekly effective on 04/30/2024. No evidence that 2 aide visits occurred during the first week of benefit period. Aide visits started on 05/07/2024. No evidence that a physician order was placed to discontinue those visits or that those visits were declined by the patient/family. Patient #3: The aide plan of care shows visit frequency as 3x/week effective on 05/23/2024. No evidence that 3 visits occurred on the week of 05/23/2024. No evidence that a physician order was placed to discontinue those visits or that those visits were declined by the patient/family. Patient #8: The aide visit frequency ordered as twice weekly effective on 03/06/2024. No evidence that any of those visit have occurred at the time of survey. No evidence that a physician order was placed to discontinue those visits or that those visits were declined by the patient/family.”

“Upon patient client record review, 1 of 14 (Patient #2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 2: RN completed the supervised visit on the LVN before the LVN ever completed an actual visit. LVN had a scheduled visit on 05/08 that was declined by the patient/family. RN completed the supervised documentation on 05/16/2024 as if the LVN had completed the 05/08/2024 visit.”