Sequoia Hospice

“Upon patient record review, 7 of 19 (Patient #1,#2,#3, #4,#5#6,#7) did not have evidence in the patient record that a review was completed of all prescription and nonprescription 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 record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions. Documentation in home indicates to give Sublingual and states “do not give in eye”. During home visit family indicated patient is taking Mirtazapine 15mg 1 by mouth at bedtime There is no evidence of this on the hospice medication profile. Corrected on site. Patient#2: The record indicates calmoseptine was ordered for topical use on admission. There is no evidence of calmoseptine on medication profile. The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions. Documentation at facility indicates to give Sublingual and states “do not give in eye”. Loperamide 2 mg 1 by mouth every 8 hours for diarrhea is listed on facility MAR as active since 7/11. There is no evidence of this on the hospice medication profile. Corrected on site. Patient#3: The record indicates hydrophillic ointment 1 inch ordered for sacral wound. There is no evidence of this medication on medication profile. The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions on medication profile. This medication was ordered for sublingual, do not give in eye. Corrected on site. Patient #4: The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions on medication profile. This medication was ordered for sublingual, do not give in eye. The facility medication list includes mighty shake every day at breakfast, prostat 30ml by mouth twice a day, and aspercreme 4% to left thigh and knee every 24 hours as needed for pain. There is no evidence of these medications on the hospice medication profile. Lorazepam 0.5 by mouth as needed is on the hospice medication profile but is not on the facility MAR. Corrected on site. Patient #5: The record indicates an order on 8/30 for providone to be applied to left heel. There is no evidence of providone on medication profile. The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions on medication profile. This medication was ordered for sublingual, do not give in eye. Corrected on site. Patient#6: The medication profile contained an order for MiraLAX, there are no instructions for diluent when preparing this medication. The medication profile contains an order for hydrocortisone, there is no specific area of application indicated. The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions on medication profile. This medication was ordered for sublingual, do not give in eye. Corrected on site. Patient#7: The record indicated for atropine 1% eye drops give 2 drops, route is listed ophthalmic for excessive oral secretions on medication profile. This medication was ordered for sublingual, do not give in eye. Corrected on site.”

“Upon patient record review, 6 of 19 (Patient #4,5,6,10,13,14) 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#4,#5,#6,#13,#14: The record indicates wound care ordered. There is no problems goals or interventions on plan of care related to wound care. Corrected on site. Patient#10: The record indicates orders for GI tube site care. There is no evidence of problems, goals, or interventions on the plan of care relate to GI site care. Corrected on site.”

“Upon patient record review 1 of 19 (Patient #2) 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#2: The aide visit frequency was 3x/week. The weeks of 6/23/24, 7/14/24, and 9/1/24, the record indicated only 2 visits for those weeks with no indication of missed visit documentation. Corrected on site.”