Amity Care

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current: Prescription and over the counter (OTC) drugs; supplements; herbal remedies; other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; actual or potential drug interactions; duplicate drug therapy; drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that medication profile contained the patient’s current prescription and over the counter drugs. Clinical Record 1: The patient elected the hospice benefit on 04/04/2024, with a terminal diagnosis of Atherosclerosis Sclerosis Heart Disease. The initial nursing assessment dated 04/04/2024 included documentation “patient is on 02 at 2L per minute as needed for shortness of breath. The medication profile dated 04/04/2024 did not include oxygen. Clinical Record 3: The patient elected the hospice benefit 08/29/2024.with a terminal diagnosis of Perforated intestines. The Initial nursing assessment dated 08/29/2024 included documentation “patient is on 02 at 2L per minute as needed for shortness of breath. The medication profile dated 08/29/2024 did not include oxygen. During a joint clinical record review and interview on 10/22/2024, the Director of Nursing confirmed that the medication profile did not include oxygen.”

“It is required that each patient’s individualized written plan of care includes medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 7 of 19 (37%) clinical records reviewed revealed the agency did not ensure medical supplies necessary to meet the needs of the patient were identified in the plan of care. Clinical Record 3: The patient elected the hospice benefit on 08/29/2024. with a terminal diagnosis of Perforation of Intestines. The RN documented on 08/29/2024 that the patient was incontinent. Chucks, diapers size XL briefs, gloves and wipes were sent to the patient’s home for incontinent care. Clinical Record 5: The patient elected the hospice benefit on 08/30/2022, with a terminal diagnosis of CHF. On 08/30/2022, the RN documented that the patient was incontinent of bowel and bladder. Chucks, diapers, briefs, gloves and wipes were sent to the patient’s home for incontinent care. Clinical Record 1: The patient elected the hospice benefit on 04/04/2024, with a terminal diagnosis of Atherosclerosis Sclerosis Heart Disease. On 04/05/2024 the RN documented that patient was incontinent of bowel and bladder. Chucks, diapers, briefs, gloves and wipes were ordered and sent to the patient’s home for incontinent care. Clinical Record 6: The patient elected the hospice benefit on 01/24//2024, with a terminal diagnosis of Senile Degeneration of Brain. On 01/24/2024 RN documented that patient was incontinent of bowel and bladder. Chucks, diapers, briefs, gloves and wipes were ordered and sent the patient’s home for incontinent care. Clinical Record 7: The patient elected the hospice benefit on 09/01/2023, with a terminal diagnosis of Alzheimer’s Disease. On 09/01/2024, the RN documented that patient was incontinent of bowel and bladder. Chucks, diapers, briefs, gloves peri wash, and wipes were ordered and sent to the patient’s home for incontinent care. Clinical Record 4: The patient elected the hospice benefit on 11/17/2022, with a terminal diagnosis of Alzheimer’s Disease. On 11/17/2022, the RN documented that patient was incontinent of bowel and bladder. Chucks, diapers size small, briefs, gloves and wipes were ordered and sent to the patient’s home for incontinent care. Clinical Record 2: The patient elected the hospice benefit on 04/11/2024, with a terminal diagnosis of Parkinson’s Disease. On 04/12/2024 the RN documented that patient was incontinent of bowel and bladder. Chucks, briefs size small, wipes and gloves were ordered and sent to the patient’s home for incontinent care. During a joint clinical record review and interview on 10/22/2024, the Director of Nursing confirmed that the plans of care for the records identified, were not individualized to include the supplies that were related to the palliation and management of the patient’s terminal illness and related conditions. No further information was provided.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. (L628) This standard was not met as evidenced by clinical record review and interview. In 4 of 15 (27%) clinical records reviewed with aide services provided, the agency did not ensure the aide reported changes to the RN. Clinical Record 1: The patient elected the hospice benefit on 04/04/2024, with a terminal diagnosis of Atherosclerosis Sclerosis Heart Disease. The hospice aide plan of care dated 09/12 2024 included an order for oral care every visit three times a week. The aide visit dated 09/13/2024 and 09/23/2024 documented patient refused oral care. There was no documented evidence that the RN was notified. Clinical Record 2: The patient elected the hospice benefit on 04/11/2024, with a terminal diagnosis of Parkinson’s Disease. The hospice aide plan of care dated 07/24 2024 included an order for oral care every visit three times a week. The aide visit dated 07/31/2024 documented patient refused oral care. There was no documented evidence that the RN was notified. Clinical Record 15: The patient elected the hospice benefit on 05/24/2024, with a terminal diagnosis of heart disease. The hospice aide plan of care dated 05/24 2024 included an order for partial bed bath 2 days a week and full bed bath 3 days a week. 05/30/2024 documented a full bed bath and a partial bed bath was provided. There was no documented evidence that the RN was notified. Clinical Record 16: The patient elected the hospice benefit on 07/15/2024, with a diagnosis of Malignant Neoplasm of the Kidney. The hospice aide plan of care dated 07/15/2024 included an order to shave and shampoo every visit. The aide visit note dated 07/23/2024 documented patient refused shampoo and shave. There was no documented evidence that the RN was informed of task not completed. During a joint clinical record review and interview on 10/22/2024, the Director of Nursing confirmed the aide did not inform the RN of tasks not performed.”