Harrison’s Hope

“Upon patient record review, 3 of 14 (Patient #3,6,9) 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: Patient 3: The medication profile contains an order for albuterol 0.083% with no dose and Polyethylene Glycol with no diluent. Corrected on site. Patient 6: The medication profile on 3/4/25 contains an order for Cyclobenzaprine 10mg 0.5-1 tab as needed. There are no instructions listed for frequency. Corrected on site. Patient 9: The medication profile contains an order for Gavilax 17gm daily with no diluent. Corrected on site.”

“Upon patient record review, 5 of 14 (Patient # 1,2,4,5,8) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: The POC 3/11/25 contains orders for ASA and Eliquis there is no risk for bleeding care plan with goals and interventions. Patient has a diagnosis of dysphagia and there is no risk for aspiration care plan with goals and interventions. Corrected on site. Pt is incontinent of bowel and bladder with frequent episodes of diarrhea and there is no care plan for risk for skin breakdown with goals and interventions. Corrected on site. Patient 2: The POC 3/13/25 the SN documented in the comprehensive assessment that the patient has dysphagia with recurrent aspiration and is a high fall risk, there was no care plan for risk for aspiration or high risk of falls with goals and interventions. Corrected on site. Patient 4: The patient had a fall during the current certification period and is incontinent of bladder, there was no fall risk or risk for skin break down care plans with goals and interventions. Corrected on site. Patient 5: Patient has a diagnosis of dysphagia with no risk of aspiration care plan and is up with a walker with no fall risk care plan with goals. Corrected on site. Patent 8: The POC contains a goal for risk for skin breakdown with no goals or interventions. Corrected on site.”

“Upon patient record review, 10 of 14 (Patient #1-10) 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 measurable outcomes are anticipated from implementing and coordinating the plan of care for each patient by using data elements identified by the hospice and is used as part of the Hospice’s QAPI program. Patient 1: The most recent revised plan of care contains a goal of “Pt caregiver verbalizes understanding of the administration and side effects of pain medication” this goal is not measurable. “Pt/caregiver/facility staff will verbalize understanding of methods to decrease choking risks and prevent aspiration” the goal is not measurable. Corrected on site. Patient 2: The most recent revised POC contains a goal of “caregiver to verbalize measures to promote comfort related to respiratory system in a terminal patient”. “Pt/caregiver verbalizes understanding of administration and side effects of pain medication”. These goals are not measurable. Corrected on site. Patient 3: The most recent revised POC contains a goal of “ Caregiver/pt. verbalizes medication (dosage route frequency) to be given to prevent constipation”. “Pt./caregiver verbalizes proper nutrition and fluid intake in order to maintain proper bowel movement”. These goals are not measurable. Corrected on site. Patient 4: The most recent revised POC contains goal “Pt/caregiver verbalizes the importance and rationale for use of support surfaces to prevent skin breakdown”. “Pt./caregiver verbalizes dietary and fluid required to promote healing process and healthy skin”. These goals are not measurable. Corrected on site. Patient 5: The most recent revised POC contains a goal of “Pt/caregiver verbalizes understanding of proper safety measures related to fall awareness”. “Pt/caregiver demonstrates appropriate measures to prevent infection”. These goals are not measurable. Corrected on site. Patient 6: The most recent revised POC contains a goal of Caregiver to verbalize understanding of seizure precautions” and Pt/caregiver verbalizes understanding of measures to manage cardiac symptoms”. These goals were not measurable. Corrected on site. Patient 7: The most recent revised POC contains a goal of “Pt/caregiver verbalizes the importance and rationale for use of support surfaces to prevent skin breakdown”. “Pt./caregiver verbalizes dietary and fluid required to promote healing process and healthy skin”. These goals are not measurable. Corrected on site. Patient 8: The most recent plan of revised POC “Pt/caregiver understands the causes of pain”. “Pt/caregiver verbalizes understanding of the administration and side effects of medication”. These goals are not measurable. Corrected on site. Patient 9: The most recent revised POC contains goals of “Pt tolerates administration of pain medication, understands the pain scale, medication regimen including administration and potential side effects”. “Pt/caregiver administers prescribed medication properly as a result of nurse filled”. “Pt/caregiver verbalizes understanding phycological effects of incontinence and measures”. These goals are not measurable. Corrected on site. Patient 10: The POC 1/30/25 contains goals of “Pt/caregiver verbalizes understanding of the administration and side effects of pain medication”. “Pt/caregiver verbalizes understanding psychological effects of incontinence and measures to improve/maintain dignity”. These goals are not measurable.”

“Upon patient record review, 3 of 14 (Patient #3,6,9) 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 3: The POC 3/1/25 contains an order for albuterol 0.083% with no dose and Polyethylene Glycol with no diluent. Corrected on site. The SN documented on 3/27/25 “pt. on 3.5L of O2” and on 3/17/25 O2 was increased from 3L to 3.5L. There was no evidence of an order for the Oxygen level to be increased. Corrected on site. Patient 6: The POC on 3/4/25 contains an order for Cyclobenzaprine 10mg 0.5-1 tab as needed. There are no instructions listed for frequency. Corrected on site. Patient 9: The POC 2/9/25 contains an order for Gavilax 17gm daily with no diluent. Corrected on site.”

“Upon patient record review, 4 of 14 (Patient #1,2,3,4) 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 equipment and supply needs. Patient 1: The skilled nurse documented on 3/17/24, “ordered gel mattress overlay” there was no order on the plan of care. Corrected on site. Patient 2: The SN documented on SOC comprehensive assessment patient has grab bars and a walker they were not included on the plan of care. Corrected on site. Patient 3: The Pt is on albuterol 0.083% solution for nebulization. There is no nebulizer added to the plan of care. The SN documented on 3/17/25 that patient is using a CPAP and is using it four hours a day instead of BIPAP every afternoon, these items were not included on plan of care. Corrected on site. Patient 4: The SN documented on 3/19/25 Pt. has a walker, hospital bed, over the bed table and a shower chair. These items were not included on the plan of care. Corrected on site.”

“Upon client record review, 1 of 14 (Patient #2) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: Upon home visit finding, the SN removed the patient’s sock to assess a wound on his great left toe for signs and symptoms of infection. She educated patient and his spouse that the wound needs to be open to air and to continue to watch for signs and symptoms of infection. There is no orders on the POC for this wound. Corrected on site.”