Life Source Services of Baton Rouge

“Based on observation, interviews, and record reviews, the provider failed to conduct comprehensive assessments to ensure the drug profile accurately reflected all medications taken for 4 (#15, #16, #17 and #18) of 4 (#15, #16, #17 and #18) patients reviewed with home visits. Findings:Review of the undated Agencys Policy titled, “;Medication Profile” revealed the following, in part:Policy: Patients receiving medications administered by hospice will have a current, accurate mediation profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications. Patient #15 Review of the Clinical Record for Patient #15 revealed she began receiving services from the Hospice Agency on 01/23/2023 and had a current Certification Period of 03/18/2024 to 05/16/2024. Patient #15 had diagnoses which included Congestive Heart Failure, Essential Hypertension and Unspecified Atrial Fibrillation. A home visit was conducted with Patient #15 on 04/24/2024 at 8:15 a.m. Patient #15 resides in a local nursing home. Patient #15s medications were reviewed during the home visit. The following medication discrepancies were identified when compared to Patient #15s Current Medication Profile provided by the Hospice Agency:Omeprazole DR 40 mg take 1 tablet by mouth daily was on the nursing homes Medication Administration Record with a start date of 10/23/2023 and was not present on the Current Medication Profile provided by the Hospice Agency. Patient #16Review of the Clinical Record for Patient #16 revealed she began receiving services from the Hospice Agency on 12/13/2023 and had a current Certification Period of 03/12/2024 to 06/09/2024. Patient #16 had diagnoses which included Unspecified Dementia, Psychotic Disturbance, Mood Disturbance, Anxiety and Hypertension. A home visit was conducted with Patient #16 and Patient #16s daughter on 04/24/2024 at 11:00 a.m. with S3SW present in the home. Patient #16s medications were reviewed during the home visit. The following medication discrepancies were identified when compared to Patient #16s Current Medication Profile provided by the Hospice Agency:Tussin DM take 10 ml by mouth every 6 hours as needed was on the medication profile with a start date of 03/31/2024, and the patient was no longer taking.Amlodipine take 5 mg by mouth daily was on the medication profile with a start date of 12/13/2023, and the patient was no longer taking.An interview was conducted with Patient #16s daughter during the home visit. She said she administered Patient #16 her medications daily. She said Patient #16 had not received Amlodipine for the last 3 months and had not received Tussin DM for over one and a half weeks. An interview was conducted with S3SW on 04/24/2024 at 11:10 a.m. during the home visit. S3SW confirmed the above medication discrepancies during the home visit. S3SW said medications should be reconciled during every home visit. Patient #17Review of the Clinical Record for Patient #17 revealed he began receiving services from the Hospice Agency on 07/21/2023 and had a current Certification Period of 03/17/2024 to 05/15/2024. Patient #17 had diagnoses which included Senile Degeneration of Brain, Cerebral Infarction, Dysphagia, Major Depressive Disorder and Vascular Dementia. A home visit was conducted with Patient #17 on 04/23/2024 at 3:20 p.m. with S4RN. Patient #17 resides in a local nursing home. Patient #17s medications were reviewed during the home visit. The following medication discrepancies were identified when compared to Patient #17s Current Medication Profile provided by the Hospice Agency:Lorazepam 1 mg by mouth at bedtime was on the medication profile with a start date of 07/21/2023, and was not present on the nursing homes Medication Administration Record. Lorazepam 1 mg by mouth every 4 hours as needed with a start date of 07/21/2023, and not present on the nursing homes Medication Administration Record. An interview was conducted with S4RN on 04/23/2024 at 3:30 p.m. during the home visit. S4RN said medications should be reconciled during every home visit. Patient #18Review of the Clinical Record for Patient #18 revealed he began receiving services from the Hospice Agency on 05/27/2023 and had a current Certification Period of 03/22/2024 to 05/20/2024. Patient #18 had diagnoses which included Sarcopenia, Hypertensive Heart Disease with Heart Failure, Chronic Kidney disease and Atrial Fibrillation. A home visit was conducted with Patient #18 on 04/23/2024 at 3:15 pm with S4RN. Patient #18 resides in a local nursing home. Patient #18s medications were reviewed during the home visit. The following medication discrepancies were identified when compared to Patient #18s Current Medication Profile provided by the Hospice Agency:Albuterol Sulfate take 1 solution for nebulization by inhalation every 6 hours as needed with a start date of 05/27/2023, and was not present on the nursing homes Medication Administration Record. An interview was conducted with S4RN on 04/23/2024 at 3:20 p.m. during the home visit. S4RN confirmed the above medication discrepancies during the home visit. S4RN said medications should be reconciled during every home visit. An interview was conducted with S1ADM on 04/25/2024 at 2:00 p.m. She was notified of the medication discrepancies found during the home visits for Patient #15, #16, #17 and #18. She stated each patients medications should have been reconciled every discipline visit and staff should review the medication bottles each visit. She verified each patients Medication Profile should have reflected what the patient was currently taking.”

“Based on interview and record review, the hospice agency failed to ensure nursing services met the needs for 2 (#10 and #12) of 3 (#8, #10 and #12) patients reviewed for pressure wounds. The agency failed to follow acceptable standards of practice for wound care by failing to complete wound assessments and weekly wound measurements, including the size and stage of the wounds by a Registered Nurse for Patients #10 and #12. Findings: Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management adapted 02/1999 revealed the following in part: Registered nurses render care that is directed towards the prevention and treatment of wounds. Wounds are a common health care challenge that often occur with or result from chronic disorders such as impaired circulation and malnutrition. Nursing care of skin/wound conditions involves the identification, assessment, management, and ongoing evaluation of patients with alterations in skin/tissue integrity that includes but is not limited to draining wounds, pressure ulcers, and vascular ulcers, and conditions resulting from incontinence, surgical procedures, and/or trauma. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning, intervention, teaching, evaluation, and supervision are the major responsibilities of the Registered Nurse in the practice setting. The registered nurse is responsible for performing a nursing assessment and physical examination for preventative and restorative nursing and for providing patient/family teaching. Recognizing that the physician must always prescribe wound care, the following roles are defined to delineate the scope of practice for each member of the nursing team members. The Registered Nurse initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following:Pressure Ulcer Assessment1. Assess the Pressure Ulcer initially and re-assess it at least weekly.1.1. Document the results of all wound assessments.Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Patient #10Review of the Clinical Record for Patient #10 revealed a start of care date of 12/12/2023. Review of the Plan of Care for certification period 03/11/2024 - 06/08/2024 revealed a diagnosis of Unstageable Left Lateral Planter Pressure Ulcer. Further review of the Plan of Care revealed orders for the following frequency of Skilled Nurse visits; 1 time a week and prn. Review of the current Physician Orders for Patient #10 revealed the following, in part: 03/04/2024 Cleanse with Normal Saline or wound cleanser, pat dry, apply collagen and Silver Alginate, cover with dry clean dressing. Perform three times a week and prn soilage. Review of the Nurses Notes for Patient #10 for the weeks of 03/11/2024 and 04/08/2024 revealed there was no documentation a weekly wound assessment was completed to include measurements of Patient #10’s Left Lateral Planter Pressure Ulcer by a Registered Nurse. Patient #12Review of the Clinical Record for Patient #12 revealed a start of care date of 03/05/2024. Review of the Plan of Care for certification period 03/05/2024 – 06/02/2024 revealed a diagnosis of Unstageable Pressure Ulcer to the Sacrum. Further review of the Plan of Care revealed orders for the following frequency of Skilled Nurse visits; 1 time a week and prn. Review of the current Physician Orders for Patient #12 revealed the following: 03/05/2024 Cleanse with wound cleanser, pat dry, apply Medi-honey and foam dressing. Review of the Nurses Notes for Patient #12 for the weeks of 03/25/2024 and 04/08/2024 revealed there was no documentation a weekly wound assessment was completed to include measurements of Patient #12’s Unstageable Pressure Ulcer to the Sacrum by a Registered Nurse. An interview was conducted on 04/25/2024 at 12:00 p.m. with S1ADM. She reviewed Patient #10 and #12s Clinical Record and verified on the weeks listed above there were no wound assessments or measurements documented by a RN. She said measurements and a description of the wound should be documented weekly by the Registered Nurse.”