Bridge Hospice

“Upon patient record review, 5 of 19 records reviewed (Patient #1, #3, #5, #7, #8) 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: The record indicated on the medication profile remedy phytoplex Z Guard zinc oxide 17%-57% Topical Paste per instructions 3 times daily. There was no evidence of where or how much paste should be applied. Corrected on site. In addition: Remedy antifungal 2% topical powder per instructions 2% topical power per instructions 4 times daily for rash. There was no evidence of of where or how much to apply. Corrected on site. Also, Oxygen 2 liters prn SOB did not have a route of administration. Corrected on site. Patient #3: The record indicated on the medication profile oxygen 2 - 4 liters prn SOB or to maintain SPO2 above 90%. There was no evidence of the route of administration. Corrected on site Patient #5: The record indicated on the medication profile oxygen 2-5 liters prn SOB. There was no evidence of the route of administration and or parameter for mild SOB or moderate to severe SOB. Corrected on site. In addition, upon home visit the patient had Fentanyl 12 mcg/hr transdermal patch on the medication administration record. There was no evidence of this medication in the patients medication box. Corrected on site. In addition, the medication profile had hydrocodone 5mg/acetaminophen 325mg po every 4 hours prn. There was no evidence of this medication in the patients medication box. Corrected on site. Also, Lorazepam 0.5mg po every 6 hours prn was on the medication profile. There was no evidence of this medication in the patients medication box. Corrected on site. Patient #7: The record indicated on the medication profile Hydrocodone 5mg/Acetaminophen 325mg one tab po Q6hours prn. In addition, Acetaminophen 650mg suppository NTE 3gm Q6hours prn and an additional order for Hydrocodone 5mg/Acetaminophen 325mg 1.5 tabs po BID. There was no evidence of maximum allowable dose for acetaminophen for all medications. Corrected on site. Patient #8: The record indicated on the medication profile NTG 0.4mg SL tablet per instructions daily for CP dissolve one tablet under the tongue every 5 minutes as needed for Chest Pain, not to exceed 3 doses then notify hospice if not relieved. There was no evidence the medication was marked as PRN and was on the MAR as scheduled.”

“Upon patient record review, 2 of 19 records reviewed (Patient #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 #9: The record indicated the start of care was 11/20/23. There was no evidence of an initial bereavement risk assessment being completed. Patient #10: The record indicated the start of care was 08/28/23. There was no evidence of an initial bereavement risk assessment being completed.”

“Upon patient record review, 4 of 19 records reviewed (Patient #1, #3, #5, #7) 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#1: The record indicated on the medication profile remedy phytoplex Z Guard zinc oxide 17%-57% Topical Paste per instructions 3 times daily. There was no evidence of where or how much paste should be applied. Corrected on site. In addition: Remedy antifungal 2% topical powder per instructions 2% topical power per instructions 4 times daily for rash. There was no evidence of of where or how much to apply. Corrected on site. Also, Oxygen 2 liters prn SOB did not have a route of administration. Corrected on site. Patient #3: The record indicated on the medication profile oxygen 2-4 liters prn SOB or to maintain SPO2 above 90%. There was no evidence of the route of administration. Corrected on site Patient #5: The record indicated on the medication profile oxygen 2-5 liters prn SOB. There was no evidence of the route of administration and or parameter for mild SOB or moderate to severe SOB. Corrected on site. Patient #7: The record indicated on the medication profile Hydrocodone 5mg/Acetaminophen 325mg one tab po Q6hours prn. In addition, Acetaminophen 650mg suppository NTE 3gm Q6hours prn and an additional order for Hydrocodone 5mg/Acetaminophen 325mg 1.5 tabs po BID. There was no evidence of maximum allowable dose for acetaminophen for all medications. Corrected on site.”

“Upon patient record review, 3 of 19 (Patient #3,16,17) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #3: The record indicated in the IDG summary on 4/17/24 the patient had 2 falls in the past 4 months. There was no evidence in the record for a safety and fall care plan. Corrected on site. Patient #16: The record indicted the patient was discharged on 03/29/23. The IDT meeting on 3/22/23 showed no evidence of discharge planning and or discussions in the IDT meeting notes. Patient #17: The record indicate the RN visit on 1/31/24 identified the patient was “confused and transitioning”. There was no evidence of a care planning for the imminent death.”

“Upon patient record review 1 of 19 (Patient #4) 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 #4: The record indicated the hospice aide frequency was ordered on 4/8/24 for 4W8. The record indicated the patient was seen on 4/8/24, 4/10/23, and 4/12/23. There was no evidence of a 4th visit between 4/8/24-4/13/24.”