Ardent Hospice & Palliative Care Southern Illinois, 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. This standard was not met as evidenced by clinical record review, observation and interview. In 4 of 11 (36%) clinical records reviewed, it was revealed the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs, supplements; herbal remedies and other alternative treatments that could affect drug therapy. Clinical Record 1: The patient elected the hospice benefit on 01/18/2024 for the diagnosis of senile degeneration of the brain. The hospice medication profile included the following medication orders, that were not listed on the facility medication profile: order dated 04/04/2024, acetaminophen 650 mg 2 tabs twice daily, for pain; and an order dated 01/18/2024 fluorouracil topical cream applied daily. Clinical Record 3 / Home Visit 3: The patient elected the hospice benefit on 03/28/2024 for the diagnosis of end-stage renal disease. During the home visit on 04/24/2024, it was observed that the patient was taking Norco 5/325 mg. However, it was not listed on the hospice medication profile. Clinical Record 5: The patient elected the hospice benefit on 12/27/2023 for the diagnosis of senile degeneration of the brain. The facility medication profile contained the following medication orders that were not listed on the hospice medication profile: order dated 12/28/2023 for hyscomine 0.125 mg q every four hours, as needed; and order dated 3/3/2024 for tylenol suppository 650 mg. Clinical Record 9: The patient elected the hospice benefit on 2/12/2024 for the diagnosis of atherosclerotic heart disease. The initial nursing assessment dated 02/12/2024, documented the patient on continuous oxygen at 5 liters per minute. The oxygen was not listed on the medication profile. During an interview and joint record review with the Administrator and Alternate Administrator on 04/24/2024, it was confirmed the medication profiles did not contain all current prescriptions.”

“It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient’s family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. This standard was not met as evidenced by clinical record review and interview. In 3 of 11 (27%) clinical records reviewed, it was revealed that the agency did not ensure an initial bereavement assessment was completed. Clinical Record 6: The patient elected the hospice benefit on 12/21/2023 for the diagnosis of atherosclerotic heart disease. Clinical record review indicated there was no evidence an initial bereavement risk assessment was completed. Clinical Record 9: The patient elected the hospice benefit on 02/12/2024 for the diagnosis of atherosclerotic heart disease. Clinical record review revealed there was no evidence an initial bereavement assessment was completed. Clinical Record 11: The patient elected the hospice benefit on 01/20/2024 for the diagnosis of Parkinson’s disease. Clinical record review revealed there was no evidence an initial bereavement risk assessment was completed. During an interview and joint record review with the Administrator and Alternate Administrator on 4/24/2024, it was confirmed an initial bereavement assessment was not completed.”

“It is required that the Interdisciplinary Group, in collaboration with the individual’s attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient’s condition requires. This standard was not met as evidenced by clinical record review and interview. In 3 of 11 (27%) clinical records reviewed, it was revealed that the agency did not ensure the individualized plan of care (POC) was revised as frequently as the patient’s condition required. Clinical Record 6: The patient elected the hospice benefit on 12/21/2023 for the diagnosis of atherosclerotic heart disease. The patient died on 1/27/2024. A nursing visit dated 01/25/2024 stated in part, “Patient continuing to decline. No food or boost since 01/20/2024. Symptoms remain palliated.” The initial plan of care was dated 12/21/2023. There was no evidence the plan of care was reviewed and revised since admission. Clinical Record 8: The patient elected the hospice benefit on 12/18/2023 for the diagnosis of senile degeneration of the brain. The initial plan of care dated 12/18/2023 included the following relevant goals: “Agitation. Patient will have lessened signs of anxiety or agitation and dyspnea. Patient will be able to breathe comfortably.” On 01/01/2024, there was an on-call nursing visit for complaints of shortness of breath, which stated in part, “Possibly COVID.” On 01/02/2024, an on-call nursing visit stated in part, “Agitation and yelling out.” The nursing visit on 01/04/2024 stated in part, “Patient in recliner agitated and restless. PPS 20%. Continues with decline.” On 01/05/2024, an on-call nursing visit stated the patient was “actively dying.” The plan of care was dated 12/18/2023. There was no evidence the plan of care was reviewed and revised since admission. Clinical Record 11: The patient elected the hospice benefit on 01/20/2024 for the diagnosis of Parkinson’s disease. A nursing visit dated 01/26/2024 stated in part, “Patient has had a decline since 01/23/2024, she is no longer able to ambulate or assist with transfers, appetite has decreased significantly and only takes bites of offered meals.” There was no evidence the plan of care was reviewed and revised since admission. During an interview and joint record review with the Administrator and Alternate Administrator on 4/24/2024, it was confirmed the care plans had not been updated with the changes identified in the comprehensive assessments.”

“It is required that 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 1 of 4 (25%) clinical records reviewed in which hospice aide services were accepted, it was revealed that the agency did not ensure the registered nurse provided specific instructions for the hospice aide. Clinical Record 4: The patient elected the hospice benefit on 01/31/2024 for the diagnosis of cerebral infarction. The initial nursing assessment and plan of care dated 01/31/2024 included an order for Keppra 500 mg for seizures. The hospice aide care plan dated 03/27/2024 included the relevant task of showering and assisting with dressing. The aide care plan did not notify the aide of the seizure precautions. During an interview and joint record review with the Administrator and Alternate Administrator on 04/24/2024, it was confirmed the RN did not include seizure precautions on the aide care plan.”

“It is required that a patient clinical record contains correct clinical information that is available to the patient’s attending physician and hospice staff. Each patient’s record includes, at a minimum, any advance directives. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, it was revealed that the agency did not ensure the clinical record contained advanced directives. Clinical Record 5: The patient elected the hospice benefit on 12/27/2023, for the diagnosis of senile degeneration of the brain. The clinical record did not include any advance directives, code status or physician orders for life sustaining treatment. During an interview and joint record review with the Administrator and Alternate Administrator on 04/24/2024, it was confirmed the clinical record did not include advance directives or indicate code status.”