Hospice Specialists of Louisiana

“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, other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following, the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. 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, interview and observation. In 1 of 19(5%) clinical records reviewed revealed the organization did not ensure a medication reconciliation was completed and medications updated to the medication profile. Home Visit 1: The patient’s date of election was 04/16/2024. The Medication Profile printed on 12/02/2024 revealed Skyrizi (150mg dose) Subcutaneous Prefilled Syringe Kit 75 mg/0.83 ml, inject one syringe subcutaneous every three months and Lorazepam 0.5mg tablet, take one-tab po [by mouth] every four hours prn [as needed] for anxiety/agitation. During Home Visit 1 on 12/03/2024 with the Licensed Practical Nurse (Personnel Record 8), the medication bottles in the home revealed Lorazepam 0.5mg tablet, take one tab po [by mouth] every six hours prn [as needed] for anxiety/agitation and Vitamin D capsules 1.25mg, take one capsule by mouth every week, last filled on 10/29/2024. The patient stated that she had been taking Vitamin D for two years and stopped taking the Skyrizi when admitted to hospice. The medication profile was not updated with the latest comprehensive assessment was the RN Recertification visit note dated 11/26/2024 During a joint record review and interview on 12/03/2024, the Director of Nursing confirmed that there was no documented evidence that the medications were reconciled at the time of each comprehensive assessment and updated to the drug profile.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 19 (5%) clinical records reviewed revealed the agency did not ensure a medication reconciliation was completed and medications updated to the medication profile and plan of care. Home Visit 2: The patient’s date of election was 11/12/2024. The medication profile was printed on 12/02/2024. During Home Visit 2 on 12/03/2024 with the Social Worker(Personnel Record 12), the medications reviewed with the paid caregiver revealed Metronidazole 500mg crush and mix with wound gel and apply to sacrum area daily last dispensed on 11/27/2024. The paid caregiver stated that she had crushed the medication, mixed it, and applied to the area each day. The paid caregiver said, “It was black and had a smell, and now it was pink and did not have any more smell.” In reviewing the clinical record, the RN Skilled Nursing Visit note 11/27/2024 lacked documentation for the Metronidazole order and instructions. The Plan of Care Order dated 12/04/2024 lacked the Metronidazole order and instructions. There was no documented evidence that the medications were reconciled and updated to the hospice medication profile and plan of care. During a joint review of the record and an interview on 12/05/2024, the Director of Nursing (DON) confirmed that no evidence of the medication was updated to the medication profile and plan of care. The DON spoke with the registered nurse case manager (RN), who reported that the wound was closed and that the Metronidazole was delivered to the home to be started if the area opened. The DON stated that if medication is needed for wound care, then it is added to the medication list and plan of care. The RN reported that the paid caregiver was instructed not to start the Metronidazole unless the wound opened.”

“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. This standard was not met as evidenced by document review, interview and observation. In 2 of 4 (50%) home visit observations revealed the agency did not ensure the staff followed the agency hand hygiene policy. Document 1: Agency Policy: “Hand Hygiene - CDC Guidelines Reference #4006”, effective 11/01/2016, stated in part, “All staff shall use the hand-hygiene techniques, as set forth in the following procedure. The CDC has recommended guidelines on when to use non-antimicrobial soap and water, an antimicrobial soap and water or an alcohol-based hand rub. (See MMWR 2002; 51 - No. RR-16, http://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf)... After contact with medical equipment/supplies in patient areas... Always after removing gloves or facemasks... Procedure: Using antimicrobial soap and water or non-antimicrobial soap and water: Wet hands and apply manufacturer’s recommended amount of soap to hands. Lather well (soap reduces surface tension enabling the removal of bacteria). Clean fingernail area (bacteria may be harbored beneath fingernails). Wash hands thoroughly, using rigorous scrubbing action for at least 15 seconds. Work lather around fingernails, top of hands, etc. (to facilitate eradication of all bacteria). Rinse hands and wrists under running water. Repeat hand-hygiene technique, if necessary (to prevent recontamination of hands). Dry hands with clean paper towel. (Multiple use towels, i.e., rolling towels, are not recommended for healthcare facilities.) Turn off faucets with used paper towel and discard. Home Visit 1: During home visit (Home Visit 1) on 12/04/2024 with the Licensed Practical Nurse (LPN) (Personnel Record 8), the LPN was observed to wash the hands with soap and water, turn off the faucet with wet hands, and use a cloth hand towel that was lying on the sink counter. The LPN was observed to use gloves during the assessment. The LPN removed the gloves. The LPN was not observed to decontaminate the hands after removing the gloves. At the end of the visit, the LPN was observed washing the hands with soap and water, turning the faucet off with wet hands, and then drying the hands with the same cloth hand towel on the sink counter. Home Visit 2: During the home visit (Home Visit 2) on 12/04/2024 with the Social Worker (SW) (Personnel Record 12), the SW was observed washing the hands with soap and water, turning the faucet off with wet hands, and then using paper towels to dry the hands. At the end of the visit, the SW was observed washing the hands with soap and water, turning the faucet off with wet hands, and then using paper towels to dry the hands. During a joint document review and interview on 12/04/2024, the Director of Nursing agreed the staff did not follow the hand hygiene policy.”