Ahava Hospice

“Upon patient record review, 3 of 14 (Patient #1,2,3) 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 Discrepancies found when compared facility MAR to Hospice Medication profile: Hospice medication profile listed Buspirone HCL 5mg orally three times daily as an active medication order, however; the facility MAR did not include this medication. RNCM also discovered this during visit and found the medication had been discontinued. (RNCM completed medication reconciliation. ) Patient #2 Discrepancies found when compared facility MAR to Hospice Medication profile: Hospice medication profile listed Morphine Concentrate 0.25ml orally every 3 hours as needed for pain/dyspnea, however; the facility MAR frequency for this medication with same dose as every 4 hours as needed for pain/dyspnea. Hospice medication profile listed Triad Hydrophilic wound paste to Sacrum daily, however; the facility MAR frequency for this medication and same dose as every shift. Hospice medication profile listed Lorazepam 1mg tablet orally every 4 hours as needed for anxiety/agitation, however; the facility MAR frequency for this medication and same dose as every 8 hours as needed for anxiety/agitation. ( RNCM completed medication reconciliation.) Patient #3 Resides in her own home and was determined by the Admission RN as being able to self-administer her medications (IDT approved). Upon home visit the patient provided surveyor the medication bottles she was currently taking. There were 4 medications that were not listed on the hospice medication profile. (Cyclobenzaprine 5mg tablet, take 1-2 tabs TID as needed for muscle pain/stiffness-Cyproheptadine 4mg, orally BID-Carbidopa/Levodopa 25-100mg, take 1 tablet orally at bedtime). (RNCM was notified by clinical director to perform a complete medication reconciliation.)”

“Upon patient record review, 3 of 14 (Patient #1,2,3) 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 Discrepancies found when compared facility MAR to Hospice Plan of Care: Hospice Plan of Care listed Buspirone HCL 5mg orally three times daily as an active medication order, however; the facility MAR did not include this medication. RNCM also discovered this during visit and found the medication had been discontinued. (RNCM completed medication reconciliation and updated the Hospice Plan of Care ) Patient #2 Discrepancies found when compared facility MAR to Hospice Plan of Care: Hospice Plan of Care listed Morphine Concentrate 0.25ml orally every 3 hours as needed for pain/dyspnea, however; the facility MAR frequency for this medication and same dose as every 4 hours as needed for pain/dyspnea. Hospice Plan of Care listed Triad Hydrophilic wound paste to Sacrum daily, however; the facility MAR frequency for this medication and same dose as every shift. Hospice Plan of Care listed Lorazepam 1mg tablet orally every 4 hours as needed for anxiety/agitation, however; the facility MAR frequency for this medication and same dose as every 8 hours as needed for anxiety/agitation. ( RNCM completed medication reconciliation and updated the plan of Care) Patient #3 Resides in her own home and was determined by the Admission RN as being able to self-administer her medications.(IDT approved). Upon home visit the patient provided surveyor the medication bottles she was currently taking. There were 4 medications without orders-(Cyclobenzaprine 5mg tablet, take 1-2 tabs TID as needed for muscle pain/stiffness-Cyproheptadine 4mg, orally BID-Carbidopa/Levodopa 25-100mg, take 1 tablet orally at bedtime). (RNCM was notified by clinical director to perform a complete medication reconciliation and update to the plan of care.)”

“Upon personnel record review, 1 of 11 (Personnel #4) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #4 competency showed evidence of observation of the following: Bathing: “Sponge” and “Tub/shower”. Shampoo: “shampoo”. (Agency added an addendum to the competency to include all techniques for Bath and Shampoo. RN is scheduled to accompany Hospice aide on visits to observe techniques over the next few days.)”