Orion Hospice and Palliative Care Inc.

“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 following, the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; and 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 and interview. In 7 of 14 (50%) clinical records reviewed, the agency did not ensure the drug profile included the patient’s current medications. Agency policy PC.M55 Medication – Profile, required in part “When a patient is admitted to hospice, a medication profile is initiated to document all of the patient’s prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy.” Clinical Record 1: The patient elected the hospice benefit on 04/15/2024. The plan of care dated 04/15/2024 to 07/13/2024 included an order to “Administer oxygen as per MD orders.” The drug profile dated 04/15/2024 did not include oxygen. Clinical Record 2: The patient elected the hospice benefit on 04/12/2024. Clinical record review revealed a physician’s order dated 04/12/2024 for “Oxygen 3 liters via nasal cannula continuously.” The drug profile dated 04/12/2024 did not include oxygen. Clinical Record 3: The patient elected the hospice benefit on 11/18/2024. The plan of care dated 11/18/2024 to 02/15/2025 included an order for the “Patient to have oxygen at 4 liters nasal cannula continuously.” The drug profile dated 11/18/2024 did not include oxygen. Clinical Record 4: The patient elected the hospice benefit on 11/14/2024. The plan of care dated 11/14/2024 to 02/11/2025 included an order for the “Patient to have oxygen at 2 liters nasal cannula as needed for shortness of breath.” The drug profile dated 11/14/2024 did not include oxygen. Clinical Record 10: The patient elected the hospice benefit on 08/07/2024. The plan of care dated 08/07/2024 to 09/24/2024 included an order for the “Patient to have oxygen at 3 liters nasal cannula continuously.” The drug profile dated 08/07/2024 did not include oxygen. Clinical Record 11: The patient elected the hospice benefit on 07/19/2024. The plan of care dated 07/19/2024 to 08/26/2024 included an order for the “Patient to have oxygen at 8 liters nasal cannula continuously.” The drug profile dated 07/19/2024 did not include oxygen. Clinical Record 12: The patient elected the hospice benefit on 04/30/2024. The plan of care dated 04/30/2024 to 06/11/2024 included an order for the “Patient to have oxygen at 3 liters nasal cannula as needed for shortness of breath.” The drug profile dated 04/30/2024 did not include oxygen. During an interview on 01/23/2025, the Director of Clinical Services reviewed the records and stated, “There is not oxygen listed on these medication profiles. We recently identified this as an issue.””

“It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. Includes all services necessary for the palliation and management of the terminal illness, including the following: Intervention to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, the agency did not ensure the individualized written plan of care included services necessary for the palliation and management of the terminal illness, including interventions to manage the patient’s symptoms. Clinical Record 1: The patient elected the hospice benefit on 04/15/2024. The plan of care dated 04/15/2024 to 07/13/2024 included an order to “Administer oxygen as per MD orders.” The order on the plan of care did not include the dose, route, and frequency of administration for the oxygen. Clinical Record 2: The patient elected the hospice benefit on 04/12/2024. Clinical record review revealed a physician’s order dated 04/12/2024 for the patient to receive “Oxygen 3 liters via nasal cannula continuously.” The plan of care dated 04/12/2024 to 07/10/2024 did not include an order for oxygen. Clinical Record 7: The patient elected the hospice benefit on 12/28/2024. The initial nursing assessment dated 12/28/2024 included documentation that the “Patient is incontinent. Family provided with incontinent care education.” The plan of care dated 12/28/2024 to 03/27/2025 did not include interventions related to the patient’s incontinence and maintenance of skin integrity. During an interview and review of records on 01/22/2025, the Director of Clinical Services confirmed that specific oxygen orders and skin integrity interventions were not included in the plans of care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN (Registered Nurse) who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 8 (25%) clinical records reviewed with aide services provided, the agency did not ensure the RN provided patient specific care instructions to the hospice aide. Clinical Record 8: The patient elected the hospice benefit on 10/29/2024. Clinical record review revealed a physician’s order dated 10/29/2024 for wound care with a wound dressing to a wound on the patient’s sacrum. The plan of care dated 10/29/2024 to 11/13/2024 included an order for “Aide 2x [two times] per week.” The aide care plan assignment dated 10/29/2024 assigned the aide to provide “Bed bath at every visit.” The aide care plan did not include instructions to the hospice aide related to the patient’s sacral wound/wound dressing and what to do if the wound dressing would become wet or dislodged during the bed bath. Clinical Record 11: The patient elected the hospice benefit on 07/19/2024. Clinical record review revealed a physician’s order dated 07/19/2024 for wound care with a wound dressing to wounds on the patient’s sacrum, bilateral hips, and right leg. The plan of care dated 07/19/2024 to 08/26/2024 included an order for “Aide 3x per week.” The aide care plan assignment dated 07/19/2024 assigned the aide to provide “Bed bath at every visit.” The aide care plan did not include instructions to the hospice aide related to the patient’s sacrum, bilateral hips, and right leg wounds/wound dressings and what to do if the wound dressings would become wet or dislodged during the bed bath. During an interview on 01/23/2025, the Director of Clinical Services reviewed the records and stated, “There are no wound dressing instructions on these aide care plans.””