Acg 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 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, interview, and observation. In 2 of 3 (67%) clinical records reviewed revealed that the agency did not ensure that the drug profile included the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy and as a result, the current medication profile was not reviewed for the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. Policy No. 2-004 Medication Profile revised 01/22/2024 stated in part “A drug regimen review will be performed at the time of initial and comprehensive assessment, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication. The review will identify drug/food interactions, potential adverse effects and drug reactions, ineffective drug therapy, duplicative drug therapy, and noncompliance with drug therapy.” Clinical Record 2/Home Visit 2: During home visit 2 with the registered nurse (RN) (Personnel Record 1) on 04/23/2024, a review of the medication profile on file at the skilled nursing home (SNF) revealed that the medication profile did not match the medications listed on the hospice medication profile effective 04/10/2024 and reviewed at the Interdisciplinary Group meeting held on 04/19/2024. Benadryl 25mg by mouth every eight hours as needed (start date 03/04/2024) and Narcan Nasal Liquid 4 mg/0.1ml as needed (start date 07/10/2023) were listed as active medications on the facility medication profile. A review of the clinical record on 04/23/2024 revealed that Benadryl and Narcan were not listed on the hospice medication profile, plan of care effective 04/10/2024, or updated plan of care effective 04/17/2024. Clinical Record 3/Home Visit 3: During home visit 3 with the hospice aide (Personnel Record 6) on 04/24/2024, a review of the medication profile on file at the assisted living facility (ALF) revealed that the medication profile did not match the medications listed on the hospice medication profile effective 04/11/2024 and reviewed at the Interdisciplinary Group meeting held on 04/19/2024. Fibercon 625 mg by mouth daily (start date 04/11/2024) and Montelukast Sodium 10mg daily (start date 03/21/2023) were listed as active medications on the facility medication profile. A review of the clinical record on 04/24/2024 revealed that Fibercon and Montelukast Sodium were not listed on the hospice medication profile, the plan of care effective 04/10/2024, or the updated plan of care effective 04/17/2024. In a joint record review and interview on 04/24/2024, the Director of Accreditation and Regulatory Compliance confirmed findings that the hospice medication profile did not match the medication profile on file at the facility for clinical record 2 and clinical record 3 and as a result, the current medication profile was not reviewed for effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring.”

“It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes information on the patient’s progress toward desired outcomes and reassessment of the patient’s response to care. The assessment update is completed as frequently as the condition of the patient requires and no less frequently than every 15 days. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 9 (11%) clinical records reviewed revealed that the agency did not ensure that the updated comprehensive assessment included information on the patient’s progress towards desired outcomes and reassessment of the patient’s response to care. Policy No. 1-016 Ongoing Comprehensive Assessment revised 01/22/2024 stated in part “1. During each home visit, the Registered Nurse or other discipline will evaluate the patient according to the care plan problems identified during the initial assessment and thereafter the comprehensive assessment. 3. Ongoing comprehensive assessments should focus on: A. Patient’s response to care.” Clinical Record 3: Skilled nursing visit on 04/04/2024 included documentation of worsening depression and stated in part “Pt states he is having worsening depression symptoms but denies thoughts of suicide.” New orders were obtained for Sertraline 50mg daily beginning 04/04/2024. A skilled nursing visit was completed on 04/09/2024. The clinical record lacked evidence that the patient’s response to new medication was assessed at the next visit and per agency policy. In a joint record review and interview on 04/24/2024, The Director of Accreditation and Regulatory Compliance confirmed findings clinical record 3 lacked evidence that the updated comprehensive assessment included information on the patient’s progress towards desired outcomes and reassessment of the patient’s response to care.”

“It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that sharing of information occurs between all disciplines providing care and services in all settings and is ongoing whether or not the care and services are provided directly or under arrangement. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 9 (11%) clinical records reviewed revealed that the agency did not ensure that sharing of information occurred between all disciplines providing care and services. Policy No. 1-011 revised 01/22/2024 Monitoring Patient’s Response/Reporting to Physician stated in part “3. The patient’s Physician and/or the Hospice Medical Director will be contacted promptly when any of the following occur: A. Changes in the patient’s condition. 4. Conferences or attempts to communicate with the Attending Physician and/or Hospice Medical Director will be documented in the medical record.” Clinical Record 2: A routine skilled nursing visit was completed on 04/16/2024. The skilled nurse documentation stated in part “Per HHA report Pt had blood blister on back of arm and RN did find large bruise with quarter sized blister on back of right arm.” The clinical record lacked evidence on the date of review (04/23/2024) that the hospice medical director and/or the hospice physician received information regarding the bruise and blister discovered during the assessment. An annotation note was added to the clinical record after the clinical record review was completed and information was shared with the Director of Accreditation and Compliance. In a joint record review and interview on 04/24/2024, The Director of Accreditation and Regulatory Compliance confirmed findings that clinical record 2 lacked evidence that the physician was notified that the patient had obtained a bruise and blister.”