Lifechoice Hospice and Palliative Care

“Upon patient record review, 8 of 14 (Patient #1,2,4,5,6,7,8,10) 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: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1- 3/11/25 Miralax order did not indicate how to mix the powder for administration on the medication profile. Patient #2- 10/23/24 Orders for Lidocaine patch do not indicate where to apply the patch, Miralax order did not indicate how to mix the powder for administration on medication profile. Patient #4- 12/26/24 Acetaminophen 650mg RS Q4PRN, 2/28/25 Tylenol ES 500mg QD and Tylenol PM 500mg QHS, no evidence indicating “Not to Exceed 4000mg or max daily dose”on medication profile. This was corrected on site. Patient #5- Duplicate orders for Sertraline 50mg ordered 3/29/25 and 4/21/25 on medication profile. This was Corrected on Site. Patient #6- 7/5/24 Orders for Tylenol 500mg 2 tabs BID and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on medication profile. This was corrected on site. Patient #7- 1/22/25 Acetaminophen 650mg RS Q4PRN, Acetaminophen 325mg 1 tab QD and Acetaminophen 325mg 2 tab BID, no evidence indicating “Not to Exceed 4000mg or max daily dose”on medication profile. This was corrected on site. Patient #8- 3/11/25, Acetaminophen 500mg 2 tabs 3x/day and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on medication profile. This was corrected on site. Patient #10- 12/4/24 Acetaminophen 325mg 2 tab Q8 PRN and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on medication profile. This was corrected on site.”

“Upon patient record review, 8 of 14 (Patient #1,2,4,5,6,7,8,10) 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 medications and treatments. Patient #1- 3/11/25 Miralax order did not indicate how to mix the powder for administration on the medication profile. Patient #2- 10/23/24 Orders for Lidocaine patch do not indicate where to apply the patch, Miralax order did not indicate how to mix the powder for administration on plan of care. Patient #4- 12/26/24 Acetaminophen 650mg RS Q4PRN, 2/28/25 Tylenol ES 500mg QD and Tylenol PM 500mg QHS, no evidence indicating “Not to Exceed 4000mg or max daily dose” on plan of care. This was corrected on site. Patient #5- Duplicate orders for Sertraline 50mg ordered 3/29/25 and 4/21/25 on medication profile. This was Corrected on Site. Patient #6- 7/5/24 Orders for Tylenol 500mg 2 tabs BID and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on plan of care. This was corrected on site. Patient #7- 1/22/25 Acetaminophen 650mg RS Q4PRN, Acetaminophen 325mg 1 tab QD and Acetaminophen 325mg 2 tab BID, no evidence indicating “Not to Exceed 4000mg or max daily dose”on plan of care. This was corrected on site. Patient #8- 3/11/25 Acetaminophen 500mg 2 tabs 3x/day and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on plan of care. This was corrected on site. Patient #10- 12/4/24 Acetaminophen 325mg 2 tab Q8 PRN and Acetaminophen 650mg RS Q4 PRN, no evidence indicating “Not to Exceed 4000mg or max daily dose”on plan of care. This was corrected on site.”

“Upon patient record review, 2 of 14 (Patient #2,9) 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 equipment and supply needs. Patient #2- SN visits on 4/11/25 and 4/16 indicated patient was bed bound with use of hoyer lift and utilizes a broda chair for mobility, no evidence of DME orders on plan of care. This was corrected on site. Patient #9- 4/19/25 orders for oxygen administration, no evidence of DME on plan of care. This was corrected on site.”

“Upon patient record review 7 of 14 (Patient #1,2,3,6,7,9,10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1- On 3/16/25 the aide began giving the patient a bed bath at each visit, but the aide plan of care did not contain this type of bath to perform. Aide visits on 4/9, 4/10, 4/12, 4/14, 4/15 and 4/17 indicated to “assist with feeding”, however no evidence that the task was completed. Aide visits 4/10 and 4/15 indicated on the care plan to perform “bed bath”, however the task was not completed and the aide documented in the summary “patient given an peri wash”. Patient #2-4/21/25 Aide checked task for bed bath “patient/caregiver refused”, however documented in the narrative that a complete bed bath was given. Patient #3-4/14/25 Aide check task for feeding assistance as “no needs”, however documented in the narrative that patient was fed. Patient #6-Aide visits 4/8, 4/11, 4/15 and 4/18/25 the aide checked the task of toileting as “patient/caregiver refused”, however commented “Assisted patient to toilet and incontinence product changed”. The aide checked “completed upon arrival” for change linen, however change linen was not an ordered task. Aide visit 4/11/25 had the tasks completed for Peri Care, Hair care and Skin care, however in the visit comments the aide stated “Family refused any care on the patient”. Patient #7-Aide visits completed 4/11, 4/14, 4/15 and 4/18 indicated linen change was completed, however the task is only ordered 1x/week. Patient #9-Aide visits completed 4/1, 4/4, 4/9, 4/12, 4/16 and 4/18/25 the aide did not complete the ordered tasks for Oral Care, Back Rub, Tidy patient area and Feeding assistance, no evidence of why the task was not completed. Patient #10-Aide visits completed on 4/3, 4/4 and 4/6/25 the aide did not complete the ordered tasks for shampoo hair and provide companionship, no evidence of why the tasks were not completed.”

“Upon patient record review 1 of 14 (Patient #9) did not have evidence in the patient record that the hospice aides report: • Changes in the patient’s medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice’s policies and procedures Patient #9-Aide visits on 4/16 and 4/19/25 indicated the patient has pain during the visit, no evidence of pain reported to RN. 4/18/25 Aide visit indicated “patient with rash on vulva, spreading to butt”, no evidence of reporting to the RN.”