Burgess Hospice

“Based on clinical record review, hospice policy review and hospice staff interview, the hospice failed to ensure the Interdisciplinary Group (IDG) performed an accurate and complete drug regimen review for 6 of 14 sampled patients (Patients #1, #3, #5, #7, #8 and #10). Failure to ensure the interdisciplinary group (IDG) members involved in the assessment of patient needs identified actual or potential issues when performing the drug regimen review (DRR) with each update to the comprehensive assessment increased the risk of unidentified side effects and actual interactions of medications. Findings include: The hospice’s policy, titled Patient Assessment, dated 11/2022, the comprehensive assessment must identify the physical, psychosocial, emotional and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort and dignity throughout the dying process. the drug profile, a review of all of the patient’s prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy. This includes, but is not limited to, identification of the following: effectiveness of drug therapy drug side effects, actual or potential drug interactions, duplicate drug therapy, drug therapy currently associated with laboratory monitoring and who can safely administer the patient’s medications. 1. Patient #1 had a start of care date of 5/23/24 and received hospice services in a private residence. a. The plan of care (POC), dated 5/23/24 to 8/20/24, included orders for the medication Levothyroxine (thyroid medication). b. The skilled nurse visit note at admission, dated 5/23/24, included a DRR. The DRR failed to identify the patient had orders for the medication Levothyroxine, which included medication associated with laboratory monitoring. Clinical record review identified the Initial IDG (Interdisciplinary group) conference was held on 6/5/24. The IDG included documentation the DDR completed. The DRR failed to identify the order for Levothyroxine, which included medications associated with laboratory monitoring. The IDG failed to include identification of drugs associated with laboratory monitoring. 2. Patient #3 had a start of care date of 4/17/24 and received hospice services in a nursing home. a. The POC, dated 4/17/24 to 7/15/24, included orders for the medication Bumetanide (diuretic medication). b. The skilled nurse visit note at admission, dated 4/17/24, included a DRR. The DRR failed to identify the patient had orders for the medication Bumetanide, which included medication associated with laboratory monitoring. The IDG meeting, dated 4/24, 5/9, 5/22, 6/5 and 6/19/24 included documentation the DDR completed. The DRR failed to identify the order for Bumetanide, which included medications associated with laboratory monitoring. The IDG failed to include identification of drugs associated with laboratory monitoring. 3. Patient #5 had a start of care date of 1/5/24 and received hospice services in a private residence. a. The POC, dated 4/4/24 to 7/2/24, included orders for the medication Lasix (loop diuretic). b. The skilled nurse visit note at admission, dated 1/5/24, included a DRR. The DRR failed to identify the patient had orders for the medication Lasix, which included medication associated with laboratory monitoring. The Initial IDG meeting notes, dated 4/24, 5/9, 5/22, 6/5 and 6/19/24, included documentation the DDR completed. The DRR failed to identify the order for Lasix, which included medications associated with laboratory monitoring. The IDG failed to include identification of drugs associated with laboratory monitoring. 4. Patient #7 had a start of care date of 1/11/24 and received hospice services in a private residence. a. The POC, dated 4/4/24 to 7/2/24, included orders for the medication Lasix (loop diuretic). b. The skilled nurse visit note at admission, dated 1/5/24, included a DRR. The DRR failed to identify the patient had orders for Ativan, Morphine and Oxycodone which include medications with potential drug interactions. The Initial IDG meeting notes, dated 4/24, 5/9, 5/22, 6/5 and 6/19/24, included documentation the DDR completed. The DRR failed to identify the orders for Ativan, Morphine and Oxycodone which include medications with potential drug interactions. The IDG failed to include identification of drugs associated with potential drug interactions. 5. Patient #8 had a start of care date of 12/21/23 and revoked services 1/15/24, and received hospice services in a private residence. a. The POC, dated 12/21/23 to 3/19/24, included orders for the medications Ativan (antianxiety medication), Hydrocodone and Morphine (narcotic pain medications). b. The skilled nurse visit note at admission, dated 12/21/24, included a DRR. The DRR failed to identify the patient had orders for Ativan, Hydrocodone and Morphine which include medications with potential drug interactions. The Initial IDG meeting notes, dated 2/4/24, included documentation the DDR completed. The DRR failed to identify the orders for Ativan, Hydrocodone and Morphine which include medications with potential drug interactions. The IDG failed to include identification of drugs associated with potential drug interactions. 6. Patient #10 had a start of care date of 1/26/24 and date of death of 1/31/24 and received hospice services in a private residence. a. The POC, dated 1/26/24 to 4/24/24, included orders for the medications Morphine, Ativan and Hydrocodone. b. The skilled nurse visit note at admission, dated 1/26/24, included a DRR. The DRR failed to identify the patient had orders for Ativan, Morphine and Hydrocodone which include medications with potential drug interactions. The IDG failed to include identification of drugs associated with potential drug interactions. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review, review of employee personnel files, hospice policy review and staff interview, the hospice failed to ensure 2 of 5 sampled hospice aides (Staff G & H) satisfactorily demonstrated competency in the performance of of basic hospice aide skills in the presence of a registered nurse prior to being assigned to perform the task independently. The hospice employed 7 hospice aides at the time of the survey. Failure to ensure hospice aides have a competent ability to perform all skills above and beyond basic hospice aide skills increased the risk that patients received inadequate or inappropriate care. The Medicare Conditions of Participation direct that the hospice aide may not independently provide any patient cares until the aide has successfully completed competency testing. According to the hospice policy tilted Home Health Aides/Hospice Aides/Homemaker, dated 7/2020, the hospice aides must pass a competency evaluation whether experienced or newly trained. The evaluation may be given without prior training for home health aide/hospice aides while, in the judgment of the agency, can pass the testing without training because they are experienced or competent from their past experience in a hospital or nursing home. For the home health aide/hospice aide in training, the competency evaluation must be successfully passed before he/she can work alone. 1. Staff G, Hospice Aide, had a hire date of 6/19/23. Staff G’s personnel file lacked documentation a Registered Nurse (RN) had administered and reviewed the written competency test, dated 7/3/24. 2. Staff H, Hospice Aide, had a hire date of 4/24/24. Staff H’s personnel file lacked documentation a Registered Nurse (RN) had administered and reviewed the undated written competency test. The personnel filed also lacked documentation a RN had observed Staff H competently perform the task of a bed bath or shampoo in bed for a patient. The above information was reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review, hospice policy review and nursing home medication administration records, the hospice failed to ensure hospice staff provided overall coordination of the hospice care in regards to the patient’s medications with the nursing home for 1 of 1 sampled patients (Patient #3) with a nursing home medication review. Failure to ensure the hospice staff provided overall coordination of the patient’s medications with the nursing home placed the patient at risk for receiving inadequate care and/or treatments needed to meet the individual needs of the patient. Findings include: Review of the hospice’s policy, titled Nursing Facility Care Plan, Coordination and Communication, dated 2/3/2023, Patient #3 had a hospice admission date of 4/17/24 and received routine home care hospice services while residing in a nursing home. Review of the clinical record revealed the following: The Plan of Care (POC), dated 4/17/24 to 7/15/24, included Interdisciplinary group (IDG) orders for skilled nursing services 1 to 3 times per week and included physician orders for medications. Review of the patient’s nursing home Physician Order Report, dated 5/20/24 to 6/20/24, identified the following medication discrepancies with the hospice’s POC and Medication Profile, dated 6/18/24, for the patient: a. The hospice medication profile included an order for albuterol sulfate inhaler aerosol solution 90 base 2 puffs every 4 hours inhalation, effective 6/27/23. b. The hospice POC had an order for refresh optive (carboxymethylcellulose-glycern) drops; 0.5-0.9 %; 2 drop 3 times a day for dry eyes. c. The nursing home’s physician orders failed to include orders for albuterol inhaler. e. The nursing home’s MAR had orders for refresh optive (carboxymethylcellulose-glycern) drops; 0.5-0.9 %; 1 drop 3 times a day for dry eyes, effective 5/25/24, and and 4 times a day as needed to affected eye, effective 4/17/24. Hospice staff failed to ensure the coordination of the patient’s medications with the patient’s nursing home. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on clinical record review, nursing home clinical record review, nursing home staff interview and hospice staff interview, the hospice failed to ensure the nursing home received copies of all required documents including physician certification of terminal illness specific to the patient and hospice benefit election form for 1 of 1 sampled patients (Patient #3) with home observation visits in nursing homes. Failure to ensure the hospice staff provided the required documentation to the nursing home staff placed the patient at risk for receiving inadequate care and/or treatments needed to meet the individual needs of the patient. Findings include: According to the hospice policy titled Coordination of Hospice Care For Nursing Facility Residents, dated 10/2011, Patient #3 had a hospice admission date of 4/17/24 and received routine home care hospice services while residing in a nursing facility (nursing home). Review of the hospice clinical record revealed the following: a. An initial CTI, dated 1/20/23 to 4/19/23, and subsequent CTI, dated 4/20/23 to 7/8/23. b. An advanced directives form dated 4/17/24. On 6/20/23 at 8:30 AM, during an interview and record review with nursing facility staff, the nursing home staff was not aware of a copy of the advanced directives form provided by the hospice that related to Patient #3. The hospice staff failed to provide a copy of the patient’s Advanced Directives form to the nursing home. The above findings were reviewed with the Administrator and Clinical Manager.”

“Based on patient clinical record review and review of hospice documentation in nursing facilities and nursing home staff interview the hospice failed to assess the education and training needs for staff of a long term care facility where 1 of 1 sampled patient (Patient #3) residing in a long term care facility at the time of the survey. Failure to educate and train the long term care (LTC) facility staff where a patient resides potentially puts the patient as risk for receiving substandard hospice philosophy based care. Findings include: During an interview on 6/18/24 at 8:23 AM, the Administrator stated the hospice has not provided education and training to staff of the nursing homes. Patient #3 had a hospice admission date of 4/17/24 and received care at a nursing home. The patient’s terminal diagnosis was hypertensive heart disease with heart failure. During an interview on 6/20/24 at 8:30 AM, the surveyor discussed Patient #3 with nursing home Staff Registered Nurse, who reported to the surveyor that the hospice had not provided any education or training to nursing home staff regarding hospice philosophy, including policies and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death and dying, individual responses to death, patient rights, appropriate forms, and record keeping requirements. The above findings were reviewed with the Administrator and Clinical Manager.”