Mary T Hospice

“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 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 the hospice populations are anticipated, and, as appropriate, preventive measurements 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 4 of 14 (29%) clinical records reviewed, it was revealed that the agency did not ensure that all current medications were included in the comprehensive assessment drug profile. Agency policy PC.M60, Medications-Profile, read in part, “A patient-specific medication profile is maintained for each patient and reviewed, at a minimum, every fifteen days. 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.” Clinical Record 3: The record revealed an initial plan of care (POC) dated 09/04/2024-12/01/2024 that read in part, “Administer oxygen as ordered.” However, the medication profile dated 09/04/2024 did not include oxygen. Clinical Record 10: The record revealed an initial POC dated 08/02/2024-10/31/2024 that read in part, “Administer oxygen at 1 liter via nasal cannula, as needed for dyspnea.” However, the medication profile dated 08/02/2024 did not include oxygen. Clinical Record 11: The record revealed an initial POC dated 02/14/2024-05/13/2024 that read in part, “Administer oxygen as prescribed.” However, the medication profile dated 02/14/2024 did not include oxygen. Clinical Record 14: The record revealed an initial POC dated 12/15/2023-03/13/2024 that read in part, “Administer oxygen as prescribed.” However, the medication profile dated 12/15/2023 did not include oxygen. During a joint record review and interview on 09/18/2024, the Administrator confirmed the findings and stated “Oxygen is not listed on any of these medication profiles.””

“It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed it was revealed that the agency did not ensure each patient’s individualized written plan of care identified planned interventions. Clinical Record 2: The record revealed an initial skilled nursing (SN) assessment dated 12/01/2023 that read in part, “Patient is incontinent of bowel and bladder putting the patient at risk for skin breakdown.” The plan of care (POC) dated 12/01/2023-01/29/2024 did not include planned interventions specific to impaired skin integrity. Clinical Record 4: The record revealed an initial SN assessment dated 08/16/2023 that read in part, “Patient is a Type 2 diabetic and checks blood sugars daily in the morning.” The initial POC dated 08/16/2023-11/14/2023 did not include planned interventions specific to diabetes. Clinical Record 7: The record revealed a physician’s order dated 08/15/2024 that read in part, “Miralax 17 grams by mouth daily, as needed for constipation. Senna 8.6 mg by mouth daily, as needed for constipation.” The POC dated 08/15/2024-11/13/2024 did not include planned interventions specific to constipation. Clinical Record 8: The record revealed an initial SN assessment dated 07/26/2024 that read in part, “Patient has wounds to both legs with dressings that are changed every 4 hours. Patient is a fall risk.” The POC dated 07/26/2024-10/24/2024 did not include planned interventions specific to leg wounds and fall risk. During a joint record review and interview on 09/18/2024, the Administrator confirmed the finding and stated “There are no interventions on these plans of care for wound care, impaired skin integrity, diabetes, constipation or fall safety.””

“It is required that each individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, it was revealed that the agency did not ensure each individualized written plan of care included measurable outcomes. Clinical Record 2: The record revealed an initial skilled nursing (SN) assessment dated 12/01/2023 that read in part, “Patient is incontinent of bowel and bladder putting the patient at risk for skin breakdown.” The plan of care (POC) dated 12/01/2023-01/29/2024 did not include measurable outcomes specific to impaired skin integrity. Clinical Record 4: The record revealed an initial SN assessment dated 08/16/2023 that read in part, “Patient is a Type 2 diabetic and checks blood sugars daily in the morning.” The initial POC dated 08/16/2023-11/14/2023 did not include measurable outcomes specific to diabetes. Clinical Record 7: The record revealed a physician’s order dated 08/15/2024 that read in part, “Miralax 17 grams by mouth daily, as needed for constipation. Senna 8.6 mg by mouth daily as needed for constipation.” The POC dated 08/15/2024-11/13/2024 did not include measurable outcomes specific to constipation. Clinical Record 8: The record revealed an initial SN assessment dated 07/26/2024 that read in part, “Patient has wounds to both legs with dressings that are changed every 4 hours. Patient is a fall risk.” The POC dated 07/26/2024-10/24/2024 did not include measurable outcomes specific to leg wounds and fall risk. During a joint record review and interview on 09/18/2024, the Administrator confirmed the findings and stated, “There are no goals for wound care, impaired skin integrity, diabetes, constipation or fall safety.””

“It is required that each individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, it was revealed that the agency did not ensure the plan of care included drugs and treatment necessary to meet the needs of the patient. Clinical Record 3: The initial plan of care (POC) dated 09/04/2024-12/01/2024 read in part, “Administer oxygen as ordered.” There was no evidence of a specific physician’s order for oxygen to include dosage, frequency and mode of delivery. Clinical Record 8: The record revealed an initial skilled nursing (SN) assessment that read in part, “Patient has wounds to both legs with dressings that are changed every 4 hours.” There was no evidence of a specific physician’s order for wound care to include type of treatment, frequency, duration, etc. Clinical Record 11: The initial POC dated 02/14/2024-04/13/2024 read in part, “Administer oxygen as prescribed.” There was no evidence of a specific physician’s order for oxygen to include dosage, frequency and mode of delivery. Clinical Record 14: The initial POC dated 12/15/2023-03/13/2024 read in part, “Administer oxygen as prescribed.” There was no evidence of a specific physician’s order for oxygen to include dosage, frequency and mode of delivery. During a joint record review and interview on 09/18/2024, the Administrator confirmed the findings and stated, “There are no orders for oxygen or wound care in these charts.””

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; and consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 2 of 9 (22%) clinical records with aide services reviewed, it was revealed that the agency did not ensure that aide services were provided as ordered in the plan of care. Clinical Record 6: The record revealed aide visit notes dated 01/03/2024, 01/10/2024 and 01/17/2024 that read in part, “Patient given a bed bath.” However, the aide care plan dated 09/18/2023 read in part, “Shower patient in shower chair every visit.” There was no evidenced the aide provided services as ordered in the plan of care. Clinical Record 13: The record revealed an aide visit note dated 12/13/2023 that read in part, “Patient’s weight obtained.” However, the aide care plan dated 12/01/2023 did not include instructions to weigh the patient. During a joint record review and interview on 09/18/2024, the Administrator confirmed the findings and stated, “The aide care plans do not include weighing the patient or giving a bed bath.””