Heartland Hospice (West Branch)

“Upon patient record review, 3 of 19 (Patient #1, 2, 5) 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 1 nursing visit 10/21/24 documents oxygen in use no evidence of oxygen on the medication profile. Patient 2 nursing visit on 5/8/24 documents oxygen in use at 2LPM, no evidence of oxygen on medication profile. Patient 5 oxygen on medication profile, no evidence of a route.”

“Upon patient record review, 3 of 19 (Patient #2, 10, 12) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 2 admitted 5/8/24, initial bereavement risk assessment completed on 5/15/24. Patient 10 admitted 10/10/23 and initial bereavement risk assessment completed on 12/19/23. Patient 12 admitted on 6/14/24 and initial bereavement risk assessment completed on 6/23/24.”

“Upon patient record review, 5 of 19 (Patient #3, 7, 8, 10, 13) 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 3 on Eliquis, no evidence of bleeding precautions. Patient 7 on aspirin, no evidence of bleeding precautions. Patient 8 with dysphasia and recurrent aspiration, no evidence of aspiration precautions. Patient 10 on aspirin, no evidence of bleeding precautions. Patient 13 on aspirin and Keppra, no evidence of bleeding or seizure precautions.”

“Upon patient record review, 1 of 19 (Patient #2) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 2 order 5/8/24 for SW and SC 1prn, no routine frequency.”

“Upon patient record review, 4 of 19 (Patient #1, 2, 4, 5) 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 1 RN visit 10/21/24 documents oxygen in use, no evidence of an order for oxygen. Patient 2 nursing visit on 5/8/24 documents oxygen in use at 2LPM, no evidence of an order for oxygen. Patient 4 nursing visit on 10/28/24 documented patient uses BIPAP 4-6hrs/night, no evidence of an order for BIPAP. Patient 5 order for oxygen, no evidence of a route.”

“Upon patient record review, 3 of 19 (Patient #2, 5, 10) 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 2 nursing visit 10/16/24 documented hospital bed, low air low mattress, and OBT, no evidence of an order for these. Patient 5 nursing visit 8/19/24 documents the use of a cane, no evidence of a DME order for the cane. Patient 10 RN visits document use of hospital bed and OBT, no evidence of a DME order for these.”

“Upon patient record review, 3 of 19 (Patient #3, 4, 7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3 order 10/15/24 for SN 1w13 and 4prn. Nursing visits completed on 10/15/24 and 10/16/24. Patient 4 initial plan of care ordered opioid count every nursing visit. Patient taking Morphine concentrate, Hydrocodone, and Morphine ER tablets. No evidence all 3 were counted on each nursing visit from 9/26/24 to 10/28/24. Patient 7 order on 7/9/24 for SW effective 7/7/24 of 1m1, 2m2 and 3 prn, MSW visits completed on 7/9/24 and 7/23/24. Order on 7/9/24 for SC effective 7/7/24 of 1m3 and 2prn, SC visits completed on 7/9/24 and 7/30/24.”

“Upon patient record review, 4 of 19 (Patient #1, 2, 8, 13) 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 1 bleeding precautions on main care plan and patient is a fall risk, no evidence of bleeding or fall precautions on the aide care plan. Patient 2 aide care plan included transfer chair/bed, bed/chair every visit prn. Aide care plan did not include aspiration, fall, or oxygen precautions. Patient 8 with dysphasia and recurrent aspiration, no evidence of aspiration precautions on the aide care plan. Patient 13 on Keppra no evidence of seizure precautions on the aide care plan.”

“Upon patient record review 2 of 19 (Patient #4, 10) 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 4 aide care plan included change linen weekly on the 1st visit of the week. Aide visits on 10/22/24 and 10/25/24 both document linen changed. Patient 10 aide care plan includes shave every visit. Aide visit on 10/22/24 documented shave not needed this visit.”