Preferred Hospice of Missouri (Northeast)

“Based on record review, observation, and interview the hospice provider failed to ensure an accurate/updated medication profile was maintained in, but not limited to, three of five full records reviewed (Records/Patients #1, #2, and #3). This deficient practice has the potential to affect all patients served by the provider. Findings included: RECORD/PATIENT #1: Review of the current hospice medication profile showed the following discrepancies with the current long term-care facility (LTCF) medication orders: - The hospice medication profile showed an order dated 07/07/2023, for fluoxetine (anti-depressant) 20 milligrams (mg) two daily. The LTCF medication orders showed an order dated 12/15/2023 for fluoxetine 20 mg one daily; - The hospice medication profile showed an order for Robitussin Cold Cough + Chest liquid 10-100 mg/5 milliliters (ml), 10 ml every four hours as needed. The LTCF orders did not include this medication; - The hospice medication profile showed an order for multivitamin/minerals one tablet daily. The LTCF orders did not include this order; - The hospice medication profile showed an order for barrier cream (skin protectant) as needed. The LTCF orders did not include this order; - The hospice medication profile showed an order for Boost (nutritional supplement) one box daily. The LTCF orders showed an order dated 12/11/2023, for house supplement twice a day; - The hospice medication profile showed an order dated 06/27/2023, for Nystatin (anti-fungal) cream to bilateral breasts and inguinal areas twice a day and as needed. The LTCF orders did not include this medication; and - The LTCF orders showed an order dated 10/30/2023, for Nystatin powder under bilateral breasts and inguinal folds every shift as needed. The hospice medication profile failed to include this order. RECORD/PATIENT #2: Observation and interview on 01/10/2024, beginning at 2:00 PM, during the patient’s home visit, showed the following medication discrepancies: -The hospice medication profile showed an order for Senna/Docusate Sodium (laxative/stool softener) 8.6-50 mg one tablet twice a day. The patients caregiver stated that the patient only took this if needed; and -The patients caregiver stated that the patient took Tylenol 325 mg two tablets as needed. The hospice medication profile failed to include this medication. RECORD/PATIENT #3: Review of the current hospice medication profile showed the following discrepancies with the current LTCF medication orders: - The LTCF medication orders showed an order dated 07/28/2023, for hyoscyamine sulfate (used to decrease saliva production) 0.125 mg one tablet two times a day for cough until 07/31/2023 and give one tablet every four hours as needed for cough and an order dated 08/02/2023, for hyoscyamine sulfate 0.125 mg two times a day for excess secretions. The hospice medication profile failed to include these medication orders; and - The hospice medication profile showed an order dated 01/19/2023, for Mucinex (expectorant) 30-600 mg one tablet twice a day for congestion. The LTCF orders showed an order dated 10/16/2023, for Mucinex 30-600 mg, one tablet every 12 hours as needed for cough. During an interview on 01/10/2024, beginning at 4:45 PM, the administrator stated that he/she expected the nurse to review the LTCF medication records. Medications should be reconciled weekly. If there were discrepancies, they should discuss that with the director of clinical services.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that interventions (based off of assessments) were included on the plan of care (POC) in two of five full records reviewed (Records/Patients #2 and #5). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Plan of Care,” showed when a patient or family member/caregiver has elected the Medicare hospice benefit, the hospice, physician, facility, patient and/or family/caregiver will communicate, establish, and agree upon a coordinated plan of care for all providers which reflects the hospice philosophy, and is based on an assessment of the individual’s needs and unique living situation in the home or facility. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to hospice services 07/07/2023 with a terminal diagnosis of prostate cancer with comorbidities of hypertension (high blood pressure) and diabetes mellitus (a metabolic disease, involving inappropriately elevated blood glucose levels). The patient was continent of bowel and bladder with incontinent episodes. The patient resided at home with a family caregiver. Review of the registered nurse (RN) recertification, dated 12/26/2023, showed the following: -The patient had the following durable medical equipment (DME) in place: *Bathtub/shower bench; *Nebulizer suction machine; *Oxygen concentrator; *Oxygen portable tank; *Raised toilet seat; *Waffle mattress: *Walker; and *Wedge. Review of the document titled, “Interdisciplinary Group (IDG) Meeting,” dated 12/26/2023, showed a note entered by the RN that stated the patient had redness to his/her bottom, with a cream in place at this time. Review of the POC, dated 12/26/2023, failed to show interventions regarding the patient’s provided DME or skin integrity status. During an interview on 01/10/2024 at 4:45 PM, the hospice administrator stated that he/she would expect these elements to be contained in the plan of care. RECORD/PATIENT #5: Review of the clinical record showed the patient was admitted to hospice services on 04/12/2023 with a terminal diagnosis of congestive heart failure (a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs). Review of the document titled, “ Licensed Practical Nurse (LPN) - Skilled Nursing (SN) Visit,” dated 12/11/2023, showed, in part, the following: -The patient was a transfer assist of two with Hoyer lift (an assistive device that allows patients to be transferred between a bed and a chair or other similar resting places, by the use of electrical or hydraulic power) as he/she was no longer able to bear weight; and - The patient’s appetite had decreased with 50% or less of meals eaten and weight loss. Review of the plan of care, dated 11/28/2023, failed to show interventions regarding the patient’s nutritional status or weight bearing status. During an interview on 01/10/2024 at 4:45 PM, the hospice administrator stated that he/she would expect these elements to be care planned for the patient.”

“Based on record review, respite (short term inpatient stay for caregiver relief) contract review, and interview the hospice provider failed to ensure they obtained a discharge summary from the inpatient facility after a patients respite stay in one of two respite records reviewed (Record/Patient #6). This deficient practice has the potential to affect all patients who receive inpatient respite care. Findings included: Review of the respite contract dated 07/07/2023, showed at the request of hospice, a copy of a hospice patients medical record and discharge summary shall be provided to hospice at the time a hospice patient is discharged from the facility. RECORD/PATIENT #6: Review of the record showed the patient was admitted to the inpatient facility for respite care on 08/03/2023. The record failed to include a discharge summary from the inpatient facility after the patients discharge. During an interview on 01/10/2024, beginning at 4:45 PM, the administrator stated that he/she did not find a discharge summary from the facility. He/she would expect a discharge summary to be in the patients record.”

“Based on contract review and interview, the hospice provider failed to ensure that the inpatient acute/respite contract stated that services would be furnished in a safe and effective manner by qualified personnel in one of one inpatient acute/respite contract reviewed. This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the inpatient acute/respite contract showed the contract failed to contain the verbiage that services would be furnished in a safe and effective manner by qualified personnel. During an interview on 01/10/2024 at 4:45 PM, the hospice administrator stated that he/she would expect the verbiage to be contained in the currently active and signed contract between the provider and the contracted facility.”

“Based on nursing facility contract review and interview the hospice provider failed to ensure the contract included the delineation of hospice/facility responsibility for bereavement services to staff in one of one nursing facility contract reviewed. This deficient practice has the potential to affect all patients that reside in a nursing facility. Findings included: Review of the nursing facility contract dated 10/20/2016, failed to include the delineation of hospice/facility responsibility for bereavement services to staff. During an interview on 01/10/2024, beginning at 4:45 PM, the administrator stated that he/she could not find that verbiage in the contract. He/she provided a blank contract that included the above provision. The administrator stated that this new contract had been faxed to the facility in August of 2023, but he/she had not been able to get the signed contract back from the facility.”

“Based on record review, observation, and interview the hospice provider failed to ensure the long-term care facility (LTCF) hospice record included the most recent plan of care (POC) in three of three home visit observations of patients that resided in a LTCF. (Records/Patients #1, #3, and #4). This deficient practice has the potential to affect all patients that reside in a LTCF. Findings included: RECORD/PATIENT #1: Review of the hospice record maintained at the LTCF, during a home visit observation, on 01/09/2024, beginning at 8:30 AM, showed it failed to contain the most recent POC. RECORD/PATIENT #3: Review of the hospice record maintained at the LTCF, during a home visit observation, on 01/10/2024, beginning at 10:00 AM, showed it failed to contain the most recent POC. RECORD/PATIENT #4: Review of the hospice record maintained at the LTCF, during a home visit observation, on 01/09/2024, beginning at 8:30 AM, showed it failed to contain the most recent POC. During an interview on 01/10/2024, beginning at 4:45 PM, the administrator stated that the most recent POC should be in the hospice records at the LTCF. They had two staff assigned to ensure this was done.”

“Based on policy review, employee file review, and interview, the hospice provider failed to ensure that a criminal background check was performed prior to first patient contact in one of five employee files reviewed (Employee #5). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Criminal Background Check,” showed prior to an applicant being offered employment by [named hospice], a criminal background check will be made by [named hospice]. EMPLOYEE #5: Review of the employee file showed the following: -Date of hire: 10/05/2023; -Date of first patient contact: 10/05/2023; and -Date of criminal background check: 10/10/2023. During an interview on 01/10/2024 at 3 PM, the hospice administrator stated that the employee has his/her first patient contact prior to receiving the results of the criminal background check.”