Vitas Innovative Hospice Care

“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 effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. 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, document review, and interview. Agency policy “Pharmacy Process” (revision date 10/16/2023) stated in part, “Each nursing updated comprehensive assessment begins with a review of the patient’s plan of care (POC) which includes current medications.” In 2 of 14 (14%) clinical records reviewed and home visits observed, the agency did not ensure that the drug profile included the patient’s current medications. Clinical Record 2/Home Visit 2: The patient elected hospice care on 10/17/2021. During the home visit on 07/17/2024, the facility’s medication administration record printed on 07/17/2024 documented Tylenol 500 mg three times daily beginning 03/25/2024. The hospice medication profile printed on 07/16/2024 did not document Tylenol 500 mg three times daily. Additionally, the hospice medication profile documented Symbicort 80-4.5 mcg 2 puffs twice a day beginning 04/27/2022; Levsin 0.125 mg every four hours as needed beginning 05/16/2022; Ditropan 5 mg every day beginning 10/07/2021; Prozac 40 mg every day beginning 10/7/2021; Robitussin 100mg every four hours as needed beginning 10/7/2021; Pyridium 100 mg every eight hours as needed beginning 03/18/2024; Ativan 0.5 mg daily beginning 03/25/2024; and Keflex 500 mg every 12 hours beginning on 03/18/2024. The facility’s medication administration record did not document Symbicort, Levsin, Ditropan, Prozac, Robitussin, Pyridium, Ativan, and Keflex. The hospice medication profile and the facility’s medication administration record did not include the same medications. Clinical Record 3/Home Visit 3: The patient elected hospice care on 04/04/2024. During the home visit on 07/17/2024, the facility’s medication administration record printed on 07/17/2024 documented Olanzapine 10 mg at bedtime beginning 04/08/2024. The hospice medication profile printed on 07/16/2024 did not document Olanzapine. The hospice medication profile did not document the patient’s medications at the facility. During a joint record review and interview on 07/18/2024, the National Patient Care Administrator confirmed the findings.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, use of gloves, mask, eye protection, or face shield depending on anticipated exposure, safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids, safe handling of soiled items in the patient’s care environment, and other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by document review, interview, and observation. Agency policy “Hand Hygiene” (updated 07/21/2023) stated in part, “Wash hands after contact with environmental surfaces in immediate vicinity of patients, before and after use of non-sterile gloves, and between tasks and procedures on the same patient.” In 1 of 3 (33%) home visit observations, the agency did not ensure that hand hygiene was performed correctly, when indicated according to the agency’s policy. Home Visit 2/Clinical Record 2: During the home visit on 07/17/2024 with the Hospice Aides (HA) [Personnel Record 12] and [Personnel Record 13], the Hospice Aides provided a bed bath. The HA [Personnel Record 12] washed their hands, donned gloves, and began care. After filling the basin, the HA [Personnel Record 12] moved the floor mat away from the bed using hands with the donned gloves on. The HA changed the gloves and resumed care. The HA [Personnel Record 12] did not perform hand hygiene after removing the soiled gloves and before donning the clean gloves. During an interview on 07/17/2024, the National Patient Care Administrator confirmed the findings and agency policy regarding hand hygiene.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary; [and] the patient’s record, if requested. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Transfer Discharge Summary” (effective 11/18/2019) stated in part, “Completed for all alive discharges, transfers, revokes, discharge from GIP, patient death for CA and TX patients; Copy sent to the attending physician.” In 1 of 2 (50%) clinical records reviewed of patients that revoked the election of hospice care or were discharged from hospice, the agency did not ensure that a copy of the hospice discharge summary was forwarded to the patient’s attending physician. Clinical Record 11: The patient elected hospice care on 10/19/2023 and revoked it on 11/19/2023 to seek aggressive treatment. The Transfer/Discharge Summary/ Instructions form dated 11/29/2023 and the clinical record did not include evidence that the summary was sent to the patient’s attending physician to assist in the post-discharge continuity of care. During a joint record review and interview on 07/17/2024, the National Patient Care Administrator confirmed that the clinical record lacked evidence that the discharge summary was sent to the patient’s attending physician.”

“Based on interviews and clinical record reviews, the agency failed to provide services as ordered in the plan of care for 2 (Client 3 and Client 6) of 14 sampled clients reviewed. This deficient practice places clients at risk for not receiving needed services and care. Findings Include: Client 3 Review of Client 3s “;Case Sheet,” revealed the agency admitted Client #3 on 12/06/23 with diagnoses that included chronic lymphocytic leukemia (a type of cancer of the blood and bone marrow), vascular dementia, and anxiety. Review of Client 3s “;Admission Orders / Hospice Certification Initial Plan of Care,” dated 12/06/23, revealed the physician ordered Client 3 to be evaluated for the need for volunteer services. Review of Client 3s clinical record revealed no evidence to indicate the agency completed an evaluation of Client 3s need for volunteer services. Client 6 Review of Client 6s “;Case Sheet,” revealed the agency admitted Client 6 on 07/21/23 with diagnoses that included cerebral atherosclerosis (hardening of the arteries) and Alzheimers disease (a progressive brain disorder). Review of Client 6s “;Admission Orders / Hospice Certification Initial Plan of Care,” dated 07/21/23, revealed the physician ordered Client 6 to be evaluated for the need for volunteer services. Review of Client 6s clinical record revealed no evidence to indicate the agency completed an evaluation of Client 6s need for volunteer services. During an interview on 01/19/24 at 9:00 AM, the National Patient Care Administrator stated the agency did not find documentation the agency evaluated Client 3 or Client 6 for the need for volunteer services. During an interview on 01/19/24 at 11:40 AM, the Patient Care Administrator (PCA) stated services should be provided as ordered in the initial plan of care, and if there was an order for services the services should be documented when completed. The PCA confirmed the agency did not find documentation the agency evaluated Client 3 or Client 6 for the need for volunteer services.”