Compassion Within Hospice

“Upon patient record review, 3 of 14 (Patient #2,#4,#7) 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#2: The record indicates patient oxygen dependent. There is no oxygen on medication profile. Corrected on site. Patient#4: The record indicates patient was ordered Oxygen 2-5 lpm NC PRN. At group home patient has lidocaine 4% patches that the caregiver indicates patient is using. There is no evidence of these items on the medication profile. Corrected on site. Patient #7: The record indicates alogliptine benzoate 25mg 1 daily on the agency medication profile. These are not listed on medication list in group home. Group home states patient is not receiving these. Ondensetron 4mg 1 daily is listed on the the group home but is not on the agency medication profile. Group home states patient refuses this medication daily. Agency discontinued this item. Diltiazem 24hr ER 1 by mouth daily is listed on the group home MAR but is not listed on agency medication profile. The patient is receiving this medication. All items were corrected on site.”

“Upon patient record review, 5 of 14 (Patient #1,#4,#6,#7.#10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient#1: The record indicates patient has been ordered oxygen 2-5lpm PRN NC. The record also indicates patient has needs regarding incontinence, fall prevention, dyspnea with exertion, and fluid retention. There is no evidence of interventions or goals for these items on the plan of care. Corrected on site. Patient#4: The record indicates the patient was ordered oxygen 2-5lpm PRN NC. The record also indicates per nurse documentation that patient is taking levetiracetam for seizures, has shortness of breathe with activity, and incontinence. There is no evidence of interventions or goals related to these items. Corrected on site. Patient#6: The record indicates the patient is at risk for falls per nursing documentation however, no interventions or goals related to this. Corrected on site. Patient #7: The record indicates that the patient is ordered oxygen and requires treatment for constipation according to nurses documentation. There is no evidence of interventions or goals related to these needs. Corrected on site Patient #10: The record indicates that the patient is at risk for skin impairment according to nurses documentation. There is no evidence of interventions or goals related to this issue. Corrected on site.”

“Upon patient record review, 3 of 14 (Patient #5,#7,#8) 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#5: The record indicated for MiraLAX 17grams powder daily PRN. There is no evidence of dilutant information. The record indicated for Nystatin cream 1000000 apply topically two times a day. There is no evidence of a specified area of application. The record indicated for miconazole powder apply twice a day. There is no evidence of a specified area of application. Corrected on site Patient#7: The record indicated for Voltaren 1% 2gm apply 4 times a day as needed for pain. There is no evidence of a specific area of application. The record indicated for MiraLAX 17grams powder daily. There is no evidence of dilutant information. Corrected on site Patient#8: The record indicated for Diclofenac sodium 1% 4gm topical every 6 hours PRN for pain. There is no evidence of specified area of application. The record indicated for Lidocaine 4% patch one time a day for pain. There is no evidence of instructions for application of patch. Corrected on site.”

“Upon patient record review, 4 of 14 (Patient #1,#2,#4,#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#1: The record indicates patient having over the bed table, hospital bed, oxygen concentrator and supplies, half rails, walker, motorized wheelchair, shower chair, incontinence supplies, hygiene supplies, and low air loss mattress. There is no evidence of equipment or supplies on plan of care. Corrected on site. Patient#2: The record indicates patient having bed, wheelchair, over the bed table, oxygen concentrator and supplies, nebulizer, bed rails, hygiene and incontinence supplies. There is no evidence of equipment or supplies on plan of care. Corrected on site. Patient#4: The record indicates patient having oxygen concentrator and supplies, wheelchair, shower chair, incontinence and hygiene supplies. There is no evidence of equipment or supplies on plan of care. Corrected on site. Patient #9: The record indicates patient having electric wheelchair, transport wheelchair, hygiene and incontinence supplies. There is no evidence of equipment or supplies on plan of care. Corrected on site.”

“Upon client record review, 4 of 14 (Patient #2,#4,#7,#10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#2: The record indicates frequency for spiritual and social work is 2 times a month. There is only one visit documented each of these disciplines for July 2024. Corrected on site Patient#4: The record indicates the frequency for spiritual care is 2 times per month. The record indicates spiritual visits were made on 9/2/24, 9/6, 9/18. There is no indication that one of these visits were PRN. The record indicates the frequency for social worker is 2 times per month. The record indicates social worker visits were made on 9/2/24, 9/11, 9/25. There is no indication that one of these visits were PRN. Corrected on site. Patient#7: The record indicates the frequency for spiritual care is 2 times per month. There is evidence of 3 visits documented in October on 10/2/24, 10/9, 10/16. There is no evidence that one of these visits is PRN. Corrected on site. Patient#10: The record indicates the frequency for spiritual care is 2 times per month. There is only evidence of one visit for August on 8/9/24. There is no evidence of missed visit documented. Corrected on site.”

“Upon patient record review 3 of 14 (Patient #1,#4,#7) 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: The record indicates the aide frequency is ordered at 2 times per week. There is evidence of only one visit being made on the week of 10/10/24. There is no evidence of missed visit documented for that week. Corrected on site. Patient#4: The record indicates the aide frequency is ordered at 2 times per week. There is evidence of only one visit made the week of 9/1/24. There is no evidence of a missed visit documented for that week. There are no evidence of visits documented for the week of 10/14 or 10/21. Corrected on site Patient#7: The record indicates the aide frequency is ordered at 2 times per week. There was only evidence of one visit made the weeks of 7/7/24 and week of 9/20. There was no evidence of missed visits documented for either of these weeks. Corrected on site.”

“Upon patient client record review, 1 of 14 (Patient #2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient#2: The record indicates on 10/24/24 nurse documented for the care giver at residential home to call Country care hospice for questions or needs. Patient is under care of compassion within hospice. Corrected on site”