Heartland Hospice (Mason)

“Upon patient record review, 4 of 14 records (Patient #6, #8, #9,#10) 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 #6: Upon observation during the home visit, the medications on the hospice documentation contained Ativan, Codeine-Guaifenesin, Ondansetron, and Risperidone. These medications were not included on the medication profile at the SNF. Patient #8: Upon observation during the home visit, the medications on the hospice documentation contained Bisacodyl, Lorazepam, Morphine solution, and Senna. These medications were not included on the medication profile at the SNF. In addition, the medication profile at the SNF contained Vitamin B-12. This was not included in the hospice documented medication profile. Patient #9: The medication profile contained Miconazorb AF 2% topical powder. Apply to affected areas with yeast as needed. There was not evidence of a specific location or a specific frequency. Corrected on site. In addition, Triamcinolone 0.1% topical ointment, apply to affected areas twice daily. There was not evidence of a specific location. Corrected on site. Patient #10: The medication profile contained Acetaminophen 325mg, 2 caps q6h prn pain or fever. There was not evidence of a parameter for the fever. Corrected on site.”

“Upon patient record review, 1 of 14 records (Patient #2) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient that reflects 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: The patient was admitted with diagnosis of fronto-temporal neuro-cognitive disorder. Documentation revealed that the patient was confused, forgetful, chair bound, incontinent of bowel and bladder, combative at times, paranoid, obsessive-compulsive, and a mental disorder. There was not evidence that that care plan included neurological goals and interventions. Corrected on site.”

“Upon patient record review, 3 of 14 records (Patient #3,#9,#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 medications and treatments. Patient #3: Documentation dated 4/25/24 indicated that a respiratory therapist was was supposed to come to the patient’s home to check if the patient needed to change his C-Pap mask. There was not evidence in the patient record that the patient wears a C-Pap mask, or was on C-Pap. Patient #9: The record contained an order for Miconazorb AF 2% topical powder. Apply to affected areas with yeast as needed. There was not evidence of a specific location or a specific frequency. Corrected on site. In addition, Triamcinolone 0.1% topical ointment, apply to affected areas twice daily. There was not evidence of a specific location. Corrected on site. Patient #10: The record contained an order for Acetaminophen 325mg, 2 caps q6h prn pain or fever. There was not evidence of a parameter for the fever. Corrected on site.”

“Upon patient record review, 1 of 14 records (Patient #12) 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 #12: An order from the medical director dated 12/29/23, read to discharge the patient on 1/2/24 for no longer being appropriate. There was not evidence that the patient was declining. There was also no evidence that a discussion occurred among the IDG regarding a discharge, or plans for preparing the patient for discharge.”

“Upon client record review, 3 of 14 records (Patient #7,#10,#13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7: The social work visit frequency was 2 every 30 days. The record indicated only 1 visit in March on 3/22/24. In addition, the nurse visit frequency was 2x/week. For the week of 4/14/24-4/20/24, the record indicated only 1 visit on 4/19/24. Patient #10: The skilled nurse visit frequency was 2x/week. For the week of 4/21/24-4/27/24, The record indicated only 1 visit on 4/22/24. Patient #13: The skilled nurse frequency was increased to daily due to imminent death on 12/1/23 at 8:18am. There was not evidence of a visit on this date.”

“Upon patient record review, 1 of 14 records (Patient #9) did not have evidence in the patient record that hospice aide assignments and duties 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 #9: The aide plan of care indicated to provide a partial sponge bath every visit when requested by patient, provide a shower every visit when requested by patient, and to provide a shampoo at every visit when requested by patient. Corrected on site.”

“Upon patient record review 4 of 14 records (Patient #6,#7,#8,#9) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #6: Nail care was listed as a task to be performed with every visit. On 4/9/24, 4/12/24, and 4/16/24. Documentation by the aide indicated that it was not done because supplies were not available. Patient #7: The aide visit frequency was 2x/week. For the week of 4/14/24-4/20/24, the record indicated only 1 visit on 4/17/24. Patient #8: The aide visit frequency was 2x/week. For the week of 4/21/24-4/27/24, the record indicated only 1 visit on 4/23/24. Patient #9: Nail care was listed as a task to be performed with every visit. On 4/1/24, 4/4/24, 4/8/24, and 4/11/24. Documentation by the aide indicated that it was not done because supplies were not available.”

“Upon patient record review 2 of 14 records (Patient #7,#9) did not have evidence of documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient #7: The aide visit frequency was 2x/week. There was not evidence of an aide supervisory visit from 2/27/24-3/15/24. Patient #9: The aide visit frequency was 2x/week. There was not evidence of an aide supervisory visit for the month of April.”