Lenox Hospice

“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, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. 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 document review, clinical record review, and interview. In 2 of 6 (33%) clinical records reviewed, the agency did not ensure that the drug profile included the patient’s current prescription and over the counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. Agency policy Number: 11.10.1 Medication Profile, revised June 2019, stated in part, “The nurse will add all new/changed medication(s) to the medication profile. Discontinued (“D/C”) medications will be documented and dated. The medication profile will be reviewed every home visit, updated as changes occur and reviewed by the Interdisciplinary Group.” Clinical Record 4: The patient elected the hospice benefit on 01/26/2023. The plan of care dated 01/26/2023 included orders for Melatonin 3 mg by mouth at bedtime and Oxygen 2-3L [liters] as needed. The hospice medication profile dated 01/26/2023 and reviewed on 01/31/2023 did not include Melatonin or Oxygen. Clinical Record 6: The patient elected the hospice benefit on 06/21/2023. The plan of care dated 06/21/2023 included orders for Oxygen 2-3L as needed. The hospice medication profile dated 06/21/2023 and reviewed on 06/27/2023 did not include Oxygen. During a joint record review and interview on 07/01/2024, the Clinical Director confirmed the medication profiles for clinical record 4 and clinical record 6 were incomplete and stated, “I didn’t realize Oxygen should be on the medication profile.””

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by document review, clinical record review, and interview. In 5 of 6 (83%) clinical records reviewed, the agency did not ensure the individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Agency policy 9.12.1 IDG Care Planning Process, revised June 2019, stated in part, “An individualized written plan of care is developed for each patient. The plan of care reflects patient and family goals and interventions based on the problems identified in the initial, comprehensive and updated comprehensive assessments. The plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including measurable outcomes anticipated from implementing and coordinating the plan of care.” Clinical Record 1: The patient elected the hospice benefit on 05/02/2024. Clinical record review revealed the Chaplain completed the spiritual assessment on 05/04/2024 and documented spiritual interventions included active listening, assisted to integrate illness/values/faith, comfort/support, crisis intervention, determined family/friend reactions, engendered hope, family/friend counseling, life review, meaning in change, ministry of presence, and prayer. The plan of care dated 05/02/2024 and the updated plan of care dated 05/14/2024 included a goal for the patient that stated, “Chaplain will be available for emotional and spiritual support prn [as needed].” The goal/outcome on the plan of care dated 05/02/2024 and the updated plan of care dated 05/14/2024 was not measurable when it did not include patient specific outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 3: The patient elected the hospice benefit on 05/11/2024. Clinical record review revealed the Chaplain completed the spiritual assessment on 05/14/2024 and documented spiritual interventions included active listening, comfort/support, determined family/friend reactions, engendered hope, life review, meaning in loss, ministry of presence, and prayer. The plan of care dated 05/11/2024 and the updated plans of care dated 05/14/2024 and 05/28/2024 included a goal for the patient that stated, “Chaplain to provide spiritual support.” The goal/outcome on the plan of care dated 05/02/2024 and the updated plans of care dated 05/14/2024 and 05/28/2024 weas not measurable when it did not include patient specific outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 4: The patient elected the hospice benefit on 01/26/2023. Clinical record review revealed the Chaplain completed the spiritual assessment on 01/27/2023 and documented spiritual interventions included active listening, assisted to nourish inner strengths, assisted to verbalize issues, comfort/support, determined family/friend reactions, encourage involvement in decision making, engendered hope, family/friend counseling, life review, meaning in change, ministry of presence, and prayer. The plan of care dated 01/26/2023 and the updated plan of care dated 01/31/2023 included a goal for the patient that stated, “Chaplain will be available for emotional and spiritual support.” The goal/outcome on the plan of care dated 01/26/2023 and the updated plan of care dated 01/31/2023 was not measurable when it did not include patient specific outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 5: The patient elected the hospice benefit on 06/19/2023. Clinical record review revealed the Chaplain completed the spiritual assessment on 06/19/2023 and documented spiritual interventions included active listening, ministry of presence, and prayer. The plan of care dated 06/19/2023 and the updated plan of care dated 06/27/2023 included a goal for the patient that stated, “Chaplain spiritual assessment and support.” The goal/outcome on the plan of care dated 06/19/2023 and the updated plan of care dated 06/27/2023 was not measurable when it did not include patient specific outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 6: The patient elected the hospice benefit on 06/21/2023. Clinical record review revealed the Chaplain completed the spiritual assessment on 06/22/2023 and documented spiritual interventions included active listening, assisted to nourish inner strengths, bereavement counseling, comfort/support, crisis intervention, determined family/friend reactions, family/friend counseling, life review, ministry of presence, patient counseling, and prayer. The plan of care dated 06/21/2023 and the updated plan of care dated 06/27/2023 included a goal for the patient that stated, “Chaplain will be available for emotional and spiritual support.” The goal/outcome on the plan of care dated 06/21/2023 and the updated plan of care dated 06/27/2023 was not measurable when it did not include patient specific outcomes anticipated from implementing and coordinating the plan of care. During a joint record review and interview on 07/01/2024, the Clinical Director confirmed the findings and stated, “I will work with the chaplain on measurable goals.””

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient’s record if requested. This standard was not met as evidenced by document review, clinical record review, and interview. In 2 of 2 (100%) clinical records reviewed where the patient revoked the hospice benefit, the agency did not ensure the discharge summary was forwarded to the patient’s attending physician. Agency policy Number: 9.29.1 Discharge Summary, revised June 2019, stated in part, “If a patient revokes the election of Hospice care, or is discharged from Hospice, the Hospice will forward to the patient’s attending physician, a copy of: The hospice discharge summary and the patient’s record, if requested.” Clinical Record 4: The patient elected the hospice benefit on 01/26/2023 and revoked the hospice benefit on 01/31/2023. The clinical record contained no documented evidence that the discharge summary was sent to the patient’s attending physician. Clinical Record 5: The patient elected the hospice benefit on 06/19/2023 and revoked the hospice benefit on 09/18/2023. The clinical record contained no documented evidence that the discharge summary was sent to the patient’s attending physician. During a joint record review and interview on 07/01/2024, the Clinical Director confirmed the findings that clinical record 4 and clinical record 5 did not include documentation that the discharge summaries were sent to the attending physicians.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders; and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by document review, clinical record review, and interview. In 2 of 2 (100%) clinical records reviewed where the patient revoked the hospice benefit, the agency did not ensure the discharge summary sent to the community attending physician included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management to assist in the post-discharge continuity of care. Agency policy Number: 9.29.1 Discharge Summary, revised June 2019, stated in part, “The Hospice discharge summary will include: A summary of the patient’s stay including treatments, symptoms and pain management.” Clinical Record 4: The patient elected the hospice benefit on 01/26/2023 and revoked the hospice benefit on 01/31/2023. The clinical record contained no documented evidence that the discharge summary included a summary of the patient’s hospice stay including treatments, symptoms, and pain management. Clinical Record 5: The patient elected the hospice benefit on 06/19/2023 and revoked the hospice benefit on 09/18/2023. The clinical record contained no documented evidence that the discharge summary included a summary of the patient’s hospice stay including treatments, symptoms, and pain management. During a joint record review and interview on 07/01/2024, the Clinical Director confirmed that the discharge summaries for clinical record 4 and clinical record 5 did not include a summary of the patient’s hospice stay, including treatments, symptoms, and pain management.”