Proactive Hospice Care, LLC

“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, and 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 hospice populations are anticipated, and as appropriate, preventive measures 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, document review and interview. In 1 of 7 (14%) clinical records reviewed, it was revealed that the agency did not ensure that medication profiles were updated for all current medications and consequently reviewed for all potential interactions. Document 5: The agency policy, Patient Care Hospice Policies and Procedures 2023, stated in part, “When a patient is admitted to hospice, a medication profile is initiated to document all of the patient’s prescription and over-the-counter drugs, herbal remedies, and other alternative treatments that could affect drug therapy. The patient’s medication profile review includes, but is not limited to: a) Determining the accuracy and completeness of the profile, b) Monitoring medication effectiveness, actual or potential medication-related effects, and untoward interactions, c) Ensuring appropriateness of the medication, the dose, route of administration, and dosage schedule, d) Ensuring that the prescribed medications are safe and appropriate and the most cost-effective solution for the patient’s symptom(s), e) Determining if there are medications that have been or may be discontinued, f) Identifying duplicate drug therapy and drug therapy associated with laboratory monitoring, g) Reviewing lab values to ensure appropriate medication dosing, h) Assisting with the determination of which medications are and are not related to the patient’s terminal illness.” Clinical Record 2: The comprehensive assessment dated 08/28/2024 included the use of oxygen. Oxygen was not included on the medication list. Consequently, the review of all medications for potential interactions was not documented. During an interview, the Administrator and Clinical manager stated, “We did miss the oxygen.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed in which a hospice aide was accepted, it was revealed that the agency did not ensure that the registered nurse prepared a hospice aide plan of care that contained clear and specific instructions for all the care the patient required. Clinical Record 4: A review of the clinical record revealed that the patient has a diagnosis of Dementia. The aide care plan dated 12/21/2023 included three baths- a shower, a partial bed bath, and a complete bed bath. The aide care plan did not include a frequency for the tasks of a bath, shampoo, mouth care, or dressing. The assigned activity included assisting with the walker, and wheelchair as tolerated by the patient leaving this task to the aide to decide. The patient was admitted with a dressing that included a kerlix wrap on the right foot. The aide’s plan of care noted a dressing on the right foot but there were no instructions for the aide if the dressing became wet or fell off during the shower. In an interview with the Administration and the Clinical Manager (CM) on 10/01/2024, both agreed that the aide care plan should have assigned a specific bath, a frequency for assisting with the walker and wheelchair, and instructions for the aide if the dressing came off or became wet while care was being provided by the aide.”