Mclean Home Care and Hospice

“Based on review of clinical records, observations, interview with agency personnel and review of agency policies for eight of nineteen patients (Patients #4, #5, #7, #8, #10, #11, #12 and #13) in the survey sample, the agency failed to develop and maintain narcotic count records for the accounting of controlled medications. The findings include: a. Patient #4 elected the hospice benefit on 10/17/2024 with diagnoses of a pancreatic mass, malnutrition, malignant neoplasm of the prostate, fractures, Alzheimers and dementia. The physicians orders for the certification period of 10/17/2024 through 01/14/2025 included nursing services one to two times per week for nursing assessments and symptom management, and social work services one to three times per month. Patient #4 had Lorazepam 0.5 milligrams (mg) one tablet by mouth every six hours as needed for restlessness or anxiety, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/milliliters (ml) 0.25 ml every three hours as needed for pain or shortness of breath in the home. b. Patient #5 elected the hospice benefit on 09/14/2024 with diagnoses of malignant neoplasm of the left lung, lymph nodes and brain. The physicians orders for the certification period of 11/13/2024 through 01/11/2025 included nursing services one to two times per week for nursing assessments and symptom management, social work services one to three times per month and Chaplin services one to two times per month. Patient #5 had Lorazepam 0.5 mg one tablet by mouth every six hours as needed for restlessness or anxiety, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/ml 0.25 ml every three hours as needed for pain or shortness of breath in the Assisted Living Facility. c. Patient #7 elected the hospice benefit on 07/10/2024 with diagnoses of Alzheimers dementia, malnutrition, cardiac disease and anemia. The physicians orders for the certification period of 01/06/2025 to 03/06/2025 included nursing services one to two times per week for nursing assessments and symptom management, social work services one to two times per month, Chaplin service evaluation and home health aide services two to three times per week. Patient #7 had Lorazepam 0.5 mg one tablet by mouth every six hours as needed for restlessness or anxiety, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/ml 5 mg every three hours as needed for pain or shortness of breath in the Assisted Living Facility. d. Patient #8 elected the hospice benefit on 11/25/2024 with diagnoses of chronic pulmonary obstructive disease, acute respiratory failure, malignant neoplasm of the left lung, type two diabetes mellitus, and chronic kidney disease. The physicians orders for the certification period of 11/25/2024 through 02/22/2025 included nursing services two to three times per week for nursing assessments and symptom management, social work services once to three times per month, and volunteer services two to nine times per month. Patient #8 had Dilaudid 1 mg/ml every three hours as needed for pain or shortness of breath, and Lorazepam by mouth concentrate 2 mg/ml 0.25 ml every four hours as needed for anxiety, agitation or restlessness in the Assisted Living Facility. e. Patient #10 elected the hospice benefit on 12/17/2024 with diagnoses of dementia, type two diabetes, cardiac disease and prostate cancer. The physicians orders for the certification period of 12/17/2024 through 03/15/2025 included nursing services one to two times per week for nursing assessments and symptom management and social work services one to three times per month. Patient #10 had Lorazepam by mouth concentrate 2 mg/ml 0.25 ml every six hours as needed for anxiety, agitation or restlessness, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/ml 0.25 ml every three hours as needed for pain or shortness of breath in the home. f. Patient #11 elected the hospice benefit on 12/19/2024 with diagnoses of dementia, cardiac disease and spinal stenosis. The physicians orders for the certification period of 12/19/2024 through 03/18/2025 included nursing services one to two times per week for nursing assessments and symptom management and social work services one to two times per month. Patient #11 had Lorazepam by mouth concentrate 2 mg/ml 0.5 ml every four hours as needed for anxiety or restlessness, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/ml 0.5 ml every four hours as needed for pain or shortness of breath in the Assisted Living Facility. g. Patient #12 elected the hospice benefit on 12/13/2024 with diagnoses of Alzheimers dementia and cardiac disease. The physicians orders for the certification period of 12/13/2024 through 03/12/2025 included nursing services two to three times per week for nursing assessments and symptom management, social work services once to two times per month and home health aide services two to three times per week. Patient #12 had Lorazepam 0.5 mg one tablet by mouth every six hours as needed for anxiety or restlessness, and Morphine Sulfate (Concentrate) by mouth solution 20 mg/ml 0.25 ml every three hours as needed for pain or shortness of breath in the home. h. Patient #13 elected the hospice benefit on 12/15/2024 with diagnoses of bladder cancer and a stage two pressure ulceration to the left buttocks. The physicians orders for the certification period of 12/15/2024 to 03/14/2025 included nursing services one to two times per week for nursing assessments and symptom management, social worker services one to three times per month and home health aide services two to three times per week. Patient #13 had Dilaudid 2 mg one tablet by mouth as needed for pain, and Lorazepam by mouth concentrate 2 mg/ml 0.5 mg every four hours as needed for anxiety or restlessness. i. Interview and review of Patients #4, #5, #7, #8, #10, #11, #12 and #13 clinical records with the Director of Hospice on 01/08/2025 at 11:30 AM, identified the agency had not developed a narcotic count record or policy to ensure controlled medications were accounted for at each nursing visit. Review of the agencys Controlled Substance Management document identified the hospice nurse would reconcile medications during every visit. This may include counting controlled substances to ensure that the proper quantities were available and were taken as prescribed by the physician.”