Amedisys Hospice

“Upon patient record review, 3 of 19 (Patient #8,#12, #15) 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 #8: Medication profile dated 1/14/2024 included Voltaren cream 1% topical gel 1inch PRN apply to the area with pain, no evidence of an area to apply. Corrected on site. Patient #12: Medication profile dated 6/29/2023 included Miralax 17GM powder daily oral PRN constipation, there was no evidence of a diluent. Corrected on site. Patient #15: Medication profile dated 4/4/2023 included polyethylene glycol 17 GM daily PO, no evidence of a diluent. Dated 4/4/2023 Beni fiber Dextran oral powder 3GM/3.6GM “per instructions” PRN daily for constipation, No evidence of a diluent.”

“Upon patient record review, 1 of 19 (Patient #13) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #13: No evidence of the comprehensive no less frequently than every 15 days. SN visit 3/11/2024, next visit 3/29/2024, 18 days.”

“Upon patient record review, 1 of 19 (Patient #16) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #16: SN visits 4/12/23, 4/19/23 and 4/25/23 did not have an assessment of wounds that were reported by SNF staff on bil feet, lt ankle and lt breast “covered with foam dressings by facility staff”. On call/triage nurse documented on 4/19/2023 Pt to hospital with wounds per daughters request, No admit, returned back to facility. Requests follow up in am for SOC (pt. was never discharged). Next SN visit made on 4/25/2023.”

“Upon patient record review, 3 of 19 (Patient #2,#4,#16) 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 #2: On SOC SN assessment found high risk of falls, No evidence of problem/goals/interventions for falls on POC. Corrected on site. Patient #4: On SOC SN assessment, noted chair bound, mas assist with ambulation and transfers, unsteady on feet. Comorbidity noted past fall with pelvic fracture, no evidence of problem/goals/interventions for falls on POC. Corrected on site. Patient #16: Patient taking Eliquis. No evidence on the POC of problems/goals/interventions or risk of bleeding.”

“Upon patient record review, 5 of 19 (Patient #5,#8,#12,#15, #16) 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: Order dated 3/7/2024 included cleanse wound with iodine cleanser, apply thera-honey, Opti foam dressing and cover with cover derm. There was no evidence of the frequency of this order. Corrected on site. Patient #8: Order dated 1/14/2024 included Voltaren cream 1% topical gel 1inch PRN apply to the area with pain, no evidence of an area to apply. Corrected on site. Patient #12: Order dated 6/29/2023 included Miralax 17GM powder daily oral PRN constipation, there was no evidence of a diluent. Corrected on site. Patient #15: Order dated 4/4/2023 included polyethylene glycol 17 GM daily po, no evidence of a diluent. Dated 4/4/2023 Beni fiber Dextran oral powder 3GM/3.6GM “per instructions” PRN daily for constipation, No evidence of a diluent. Patient #16: Pt resides in SNF. SN notes dated 4/12/2023 included “staff notified of pt. developing blisters to bil. feet, facility covered with foam dressings”. 4/19/2023 and 4/25/2023 included staff notified of pt. developing blisters to bil. feet and lt. breast. Pus draining from lt. ankle, facility covered with foam dressings. No evidence of orders in hospice record.”

“Upon patient record review, 3 of 19 (Patient #2, #6, #16) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #2: Diagnosed with Covid19 on 4/8/2024. No inclusion in the POC of problems/goals/interventions for Covid19. IDG on 4/18/2024 did include isolation precautions for patient. Patient #6: Pt coughing up blood, no evidence of this new problem in an updated POC. Patient #16: Pt resides in SNF. SN notes dated 4/12/2023 included “staff notified of pt. developing blisters to bil. feet, facility covered with foam dressings”. 4/19/2023 and 4/25/2023 included staff notified of pt. developing blisters to bil. feet and lt. breast. Pus draining from lt. ankle, facility covered with foam dressings. No evidence problem/goals/interventions of wounds added to POC.”

“Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #1: After sanitizing hands removed BP cuff and pulse ox from clean bag. After using them and placing on barrier reached back into clean bag for thermometer and stethoscope without re-sanitizing hands. Not following policy PCP-002 “always perform hand hygiene before entering bag”. Patient #3: SN wore same gloves for removing items from clean bag, using on pt. during pt. care, and cleansing items and placing back into clean bag.”

“Upon patient record review, 8 of 19 (Patient #2, #4, #9, #11, #12, #13, #16, #17) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: SOC SN assessment found pt. to be high fall risk, no evidence of fall precautions on aide POC/assignment. Pt diagnosed with Covid19 4/8/2024, no evidence of Covid19 precautions added to aide assignment/POC. Corrected on site. Patient #4: Pt has history of falls, SON assessment at SOC identified unsteady gait, max assist, needs assist for ambulation and transfers, no evidence on the aide assignment of falls risk/precautions. Corrected on site. Patient #9: On SN SOC assessment pt. found to be high risk for falls, no evidence on the aide POC/assignment of fall precautions. Corrected on site. Patient #11: On SN SOC assessment pt. found to have dysphagia, pt. on O2, no evidence on the aide POC/assignment with oxygen or aspiration precautions. Corrected on site. Patient #12: Patient is taking Eliquis, no evidence on the aide POC/assignment for bleeding precautions. Patient #13: Patient is on Aspirin, No evidence of bleeding precautions on the aide POC/assignment sheet. Corrected on site. Patient #16: On SN SOC assessment pt. found to be aspiration risk, and was taking Eliquis. No evidence of bleeding or aspiration precautions on the aide POC/assignment sheet. Patient #17: On SN SOC pt. high risk for falls, on O2. No evidence of O2 or fall precautions on the aide POC/assignment sheet.”

“Upon patient record review, 1 of 19 (Patient #3) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient’s clinical information and provide written documentation that it is anticipated that the patient’s life expectancy is 6 months or less. Patient #3: CTI completed by Medical director for BP1, dated 8/18/2023 and signed 8/23/23 included “Mrs. R. is Mr. M. a 89 year old, included pronouns He, Him, His, with a diagnosis of CVA, Vasc. Disease, Liver disease,etc..” Pt is a 79 year old female with Severe Protein malnutrition. The document has been amended, corrected on site.”

“Upon client record review, 1 of 19 (Patient #3) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #3: Order dated 4/22/2024 included Cleanse pressure ulcer wound with wound cleanser, apply collagen alginate,cover with border dressing, change daily and PRN for soiling or dislodgment. there was no evidence on who was to perform this treatment, patient resides in SNF. Corrected on site.”

“Upon patient record review, 1 of 19 (Patient #2) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice’s 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient #2: During HV to SNF there was no evidence of physician certification in patients record. Corrected on site.”