Madison Hospice, Inc.

“Upon patient record review, 4 of 14 (Patient 2, 3, 4 & 5) 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 2 Patient 2 medication profile includes “Tylenol 500 mg tab 1 tab orally every 8 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit. Patient 3 medication profile includes “Bacitracin first aid ointment 500u topically twice daily for possible skin infection due to cat bite with no location identified, “Medrol dose pack 4mg tab 1 tab orally for 6 days as directed on package labeling” with no frequency; unclear instructions”, and “Tylenol 500 mg tab 1 tab orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit. Patient 4 medication profile includes “Tylenol 325 mg tab 2 tabs orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit and “Fluocinonide 0.05% topical ointment thin layer topically twice daily prn scar” with no location identified and reason unclear. Patient 5 medication profile includes “Tylenol 325 mg tab 2 tabs orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever and Tylenol 650 mg tab 1 tab po every 6 hours as needed for pain” with no daily dosage limit.”

“Upon patient record review, 1 of 14 (Patient 8) 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 8 plan of care noted “MSW initial assessment within 5 days of SOC, recert and as needed for psychosocial need mgmt and support” with no quantifier for as needed visits.”

“Upon patient record review, 4 of 14 (Patient 2, 3, 4 & 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 medications and treatments. Patient 2 plan of care includes “Tylenol 500 mg tab 1 tab orally every 8 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit. Patient 3 plan of care includes “Bacitracin first aid ointment 500u topically twice daily for possible skin infection due to cat bite with no location identified, “Medrol dose pack 4mg tab 1 tab orally for 6 days as directed on package labeling” with no frequency; unclear instructions”, and “Tylenol 500 mg tab 1 tab orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit. Patient 4 plan of care includes “Tylenol 325 mg tab 2 tabs orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever” with no daily dosage limit and “Fluocinonide 0.05% topical ointment thin layer topically twice daily prn scar” with no location identified and reason unclear. Patient 5 plan of care includes “Tylenol 325 mg tab 2 tabs orally every 6 hours as needed for pain and Acetaminophen supp 650 mg 1 supp rectally every 6 hours as needed for mild pain/fever and Tylenol 650 mg tab 1 tab po every 6 hours as needed for pain” with no daily dosage limit.”