Apex Hospice

“Upon patient record review, 1 of 14 (Patient #4) 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#4: Documentation on nurse visit on 8/12 indicates Cipro 500mg BID was ordered for 7 days for UTI. There was no evidence this was added to medication profile. Corrected on site.”

“Upon patient record review, 7 of 14 (Patient #1,#2,#3,#4,#5,#8,#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 is IDDM that is on insulin sliding scale, has dysphagia, incontinence, and has a pure wick in use. There was not evidence of problems goals or interventions on plan of care related to these issues. There is no evidence the plan plan of care included problems goals or interventions for spiritual care being provided. Corrected on site. Patient#2: The patient was admitted with diagnosis of senile degeneration of the brain. The record also indicates patient has oxygen in the home. There is no evidence the plan of care includes problems goals or interventions related to terminal illness or oxygen use. Corrected on site. Patient#3: The patient was admitted with a diagnosis of Alzheimer’s. There is also documentation patient has type 2 DM and receives wound care. There is no evidence that the plan of care includes problems interventions or goals related to these needs. Corrected on site. Patient#4: The patient was admitted with a diagnosis of dementia. There is no evidence of problems goals or interventions related to the terminal illness. There is also documentation that patient has PEG tube, foley, and has order for Jevity for feedings. There is no evidence of the plan of care including problems goals or interventions related to these issues. Patient#5: The patient was admitted with diagnosis of senile degeneration of the brain. There is no evidence of plan of care including problems goals or interventions related to terminal diagnosis. Corrected on site. Patient#8: The record indicates patient receiving care for left calf wound and left heel wound There is no evidence of wound care order on plan of care for interventions goals or progress. Corrected on site. Patient#10: The record indicates patient receiving wound care for stage 2 pressure ulcer to sacral. There is no evidence of wound care order on plan of care for interventions goals or progress. Corrected on site.”

“Upon client record review, 3 of 14 (Patient #1,#2,#3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#1: The visit frequency on plan of care for Chaplain is 2-4/month on admission. In the month of July Chaplin completed 5 visits. The visit frequency for nurse is 2x week and no PRN. There is documentation of nurse making PRN visit on 6/27 and 8/7. Corrected on site. In addition, the visit frequency for social worker was 1/month on plan of care. There was no indication of PRN visits ordered on plan of care. There was a MSW PRN visit documented on 7/9. Corrected on site. Patient#2: The visit frequency on plan of care for chaplain was 1/week. There is no evidence of a visit the week of 6/9. Corrected on site. Patient#3: The visit frequency on the plan of care for Chaplain is 4/month and 3 prn. Documentation indicates 5 scheduled visits made in August. There is no evidence of visits being PRN. Corrected on site.”

“Upon patient record review 2 of 14 (Patient #2,#3) 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#2: The order for aide frequency of visits indicates 3 visits per week. For the week of 6/2 the record indicates only 2 visits were made with no evidence of missed visit documentation. Corrected on site. Patient#3: The order for aide frequency of visits indicates 3 visits per week. For the week of 7/14 the record indicates 1 visit was made on 7/14 with no evidence of missed visit documentation. Corrected on site.”

“Upon patient client record review, 2 of 14 (Patient #4,#5) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services. Patient#4: The record indicates on 7/5 during LVN visit administered levsin x 1 dose was administered as ordered for management of secretions. There is no evidence of follow-up with or response to symptom management. The record indicates on 7/22 during RN visit, nurse administered morphine 0.5 ml for restlessness and grimacing. Documentation indicates 20 min later patient still restless and then administered lorazepam 1 mg per orders. There was no evidence with or response to symptom management. Patient#5: The record indicates on 5/3 during RN visit the patient was in pain indicated by facial grimacing during aide bath. Caregiver gave tramadol 50mg by mouth. There is no evidence of with or response to symptom management.”