Quality Care Hospice

“Upon patient record review, 3 of 19 (Patient # 1, 3 and 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: Patient 1: Upon home visit, agency medication list contains multiple medications with oral route of administration and patient has a PEG tube in place and all medications are being administered enterally via PEG tube at facility. Patient is receiving PEG tube feedings of Osmolyte 20h/day via PEG tube with no evidence on the medication profile. Corrected on site with updated profile. Patient 3: Upon home visit, Tramadol is noted on the ALF medication profile and agency medication profile does not list this medication. Corrected on site with updated profile. Patient 4: Upon home visit, agency medication profile contains incomplete orders for nasal spray without directions for use and Miralax 17 grams dose 1 powder without directions for diluent. Corrected on site with updated profile.”

“Upon patient record review, 1 of 19 (Patient #4) 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 4: The POC contains an order for Eliquis 5mg BID with no evidence of risk for bleeding on POC 7/3/25.”

“Upon patient record review, 2 of 19 (Patient #3, 4) 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: Upon home visit, the updated POC does not contain an order for Tramadol which is noted on the patient’s medication list at her place of residence. Corrected on site with agency collaboration with ALF and obtained new physician order and POC updated. Patient 4: The initial POC on 10/31/24 and updated POC 7/3/25 contains an incomplete order for nasal spray without directions for use and Miralax 17 gm dose powder without directions for diluent. Corrected on site with updates to current POC and orders received for complete orders.”

“Upon patient record review, 2 of 19 (Patient #6, 9) 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 6: Updated POC 6/21/25 contains orders for nebulizers with no nebulizer equipment listed on updated POC at recertification. Corrected on site with updated POC. Patient 9: Initial POC 5/10/25 contains orders for Nebulized medications including Stiolto Respimat and albuterol noted on medication profile without equipment listed as ordered on the POC. Corrected on site with updated POC.”

“Upon patient record review, 2 of 19 (Patient #1, 8) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 1: Initial POC 5/10/24 does not contain evidence of a PEG tube with feeding Osmolyte 20 hour daily and PEG tube maintenance, care and equipment details are not included in the initial POC. POC contains “SN to provide orders per wound care orders” without wound care details. Corrected on site by obtaining more detailed orders and updates to the POC. Patient 8: The initial POC 6/25/25 mentions NG, Trach, Peg tube with no specific order details regarding assessment, treatment orders, dressing, care of NG, PEG or trach maintenance. No supplies or equipment orders noted on POC.”

“Upon patient record review, 2 of 19 (Patient #1, 8) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 1: POC contains “SN to provide orders per wound care orders” without wound care details on who will be providing the wound care either by SNF or agency SN. Corrected on site by obtaining more detailed orders and updates to the POC. Patient 8: The initial POC 6/25/25 mentions NG, Trach, Peg tube with no details on who will be providing this care at SNF.”