Heartland Hospice (Kansas City)

“Upon patient record review, 5 of 19 (Patient #1,#2,#3,#10,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: Upon home visit observation, the patient identified use of Vitamin C, B12, and D3 daily that were not included on the medication profile, and 15mg of melatonin instead of the 10mg identified on the hospice profile. Corrected on site. Patient 2: The medication profile contained duplicative listings of metoprolol. Corrected on site. Patient 3: The medication profile contained duplicative listings of alprazolam for 1 tablet three times a day and 1 tablet at bedtime. There was no evidence of instructions to clarify if to be taken together for a total of four administrations or if one was invalid. Corrected on site. Patient 10: The medication profile contained two listings of Lantus insulin for 10 units daily and 12 units at bedtime. There was no evidence of instructions for allowable timeframe between the doses. Corrected on site. Upon home visit observation, the facility medication profile and hospice profile did not match. The facility profile contained a bisacodyl suppository daily PRN, Lantus insulin 10 units twice daily, and lorazepam 0.25mg hourly PRN. The hospice profile contained a glycerin suppository daily PRN, Lantus 10 units in the am and 12 units at bedtime, and lorazepam 0.25mg every 4 hours PRN. Patient 14: The medication profile contained Tylenol listed as scheduled instead of PRN in error. Correct on site.”

“Upon patient record review, 2 of 19 (Patients #1,#9) 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 1: The medical record contained an initial bereavement assessment 12/15/23 with a start of care 5/16/23. Patient 9: There was no evidence of a bereavement assessment.”

“Upon patient record review, 6 of 19 (Patients #3,#5,#9,#10,#11,#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 3,13: The medical record contained nursing documentation since admission identifying patient was a high risk for falls. There was no evidence of problems, goals, and interventions related to fall safety included in the plan of care. Corrected on site. Patient 5: The medical record contained nursing documentation upon admission identifying patient has a seizure disorder. There was no evidence of problems, goals, and interventions related to seizure precautions included in the plan of care. Corrected on site. Patient 9: The medical record contained nursing documentation since 8/16/24 identifying patient use of oxygen. There was no evidence of problems, goals, and interventions related to respiratory dysfunction or oxygen use included in the plan of care. Corrected on site. Patient 10: The medical record contained nursing documentation since admission identifying patient use of oxygen. There was no evidence of problems, goals, and interventions related to respiratory dysfunction or oxygen use included in the plan of care. Corrected on site. Patient 11: The medical record contained nursing documentation upon admission identifying patient has dysphagia and is insulin dependent requiring blood glucose checks four times daily. There was no evidence of problems, goals, and interventions related to dysphagia and endocrine dysfunction included in the plan of care. The plan of care also indicated the patient is DNR in error, patient is full code. There was no evidence of a DNR order or equivalent advance directive included in the medical record. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #3,#10,#14) 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: The medical record contained two orders for alprazolam with no instructions to administer simultaneously for a total of four administrations. Corrected on site. Patient 10: The medical record contained two orders for Lantus insulin10 units daily and 12 units at bedtime. There was no evidence of instructions for allowable timeframe between the doses. Corrected on site. Patient 14: The medical record contained an order for tylenol listed as scheduled instead of PRN in error. Correct on site.”

“Upon patient record review, 4 of 19 (Patients #5,#6,#11,#12) 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 5: The medical record contained nursing documentation 10/10/24 identifying the patient had a Hoyer lift and specialty mattress. There was no evidence of orders for DME included in the plan of care. Corrected on site. Patient 6: The medical record contained nursing documentation upon recertification 7/31/24 identifying patient use of a wheelchair. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site. Patient 11: The medical record contained nursing documentation identifying patient use of fall mats for safety and oxygen listed on the medication profile. There was no evidence of orders for the DME included in the plan of care. Corrected on site. Patient 12: The medical record contained nursing documentation since admission identifying use of a hospital bed, and use of a sit to stand lift for transfers since 9/24/24. There was no evidence of orders for the DME included in the plan of care. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #15,#16,#17) did not have evidence the hospice offers bereavement counseling that includes completing all tasks included in the bereavement care plan. Patient 15: There was no evidence the bereavement care plan tasks of sending 6 and 9 month newsletters and support group invitations were completed. Patient 16: There was no evidence the bereavement care plan tasks of sending 3 month newsletters and support group invitations were completed. Patient 17: There was no evidence the bereavement care plan tasks of sending 6 month newsletters and support group invitations were completed.”

“Upon patient record review, 3 of 19 (Patients #5,#6,#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 5: The medical record contained nursing documentation 10/10/24 identifying patient use of a Hoyer lift for transfers. There was no evidence of instructions for use of a Hoyer included on the aide care plan. The aide care plan stated to use a gait belt for all transfers. Corrected on site. Patient 6: The medical record contained nursing documentation identifying the patient was wheelchair bound and formerly able to ambulate with stand by assist utilizing a walker during the previous benefit period. There was no evidence of transfer instructions on the aide care plan. The aide care plan stated to walk beside the patient. Corrected on site. Patient 13: There was no evidence of instructions for transfer assistance required for safety on the aide care plan. Corrected on site.”