Caringedge Hospice of Minot

“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 interaction, 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, interview and observation. In 1 of 19 (5%) clinical records reviewed, it was revealed that the agency did not ensure that the drug profile was updated per hospice policy and procedure, but at minimum, at the time of each comprehensive assessment, and/or when a new medication was added, or changes made to an existing medication. Document 1: Agency policy titled, Medication Profile Policy No. 2-004, stated in part, “7. 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.” Home Visit 2/Clinical Record 2: The patient elected the hospice benefit on 07/27/2022 with a terminal diagnosis of heart failure. During the home visit, conducted on 12/18/2024 with the Registered Nurse (RN)(PR#2), at a skilled nursing facility (SNF), a review of the drug profile and the skilled nursing facility (SNF) drug profile, revealed the following medications were included on the SNF drug profile but were not on the hospice drug profile: calcium carbonate 500 mg every 2 hours as needed (ordered 10/19/2023), Milk of Magnesia 10ml by mouth as needed for constipation, Guaifenesin liquid 200mg every 4 hours as needed for cough (ordered 10/24/2024), Refresh Liquigel 1 drop both eyes at night (ordered 06/13/2023), Solifenacin 10mg by mouth at night for urinary incontinence (ordered 09/03/2024), and Acetaminophen 325mg 2 tablets every 4 every 4 hours as needed for pain (ordered 08/24/2024). The following medication was included on both the hospice drug profile and the SNF drug profile, but did not match: Eucerin cream 1 application topical daily as needed for dry skin was listed on the hospice drug profile and Eucerin Cream 1 application topical 2 times a day to dry skin was listed on the SNF drug profile. The following medications were listed on the hospice drug profile but not on the SNF drug profile: Triple Antibiotic ointment 3.5mg-400 unit- 5,000 units/gram topical 1 application as needed for ingrown toenail (ordered on 12/08/2023 and discontinued on 01/08/2024) and Triad Wound Dressing Paste 1 application topical apply to wound on Left Lower Extremity 3 times a week on Tuesday, Friday, and Sunday and PRN (ordered on 09/11/2024 and discontinued 10/01/2024), and Lorazepam 1 mg oral tablet 1 tablet every 4 hours as needed for anxiety. (Ordered 02/21/2024) An interview was conducted with the Director of Nursing on 12/18/2024 and it was confirmed that the hospice did not ensure that the drug profile was updated as per agency policy.”

“It is required that each patient’s individualized written plan of care reflects patient and family goals, and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments 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 2 of 19 (11%) clinical records reviewed, it was revealed that the agency did not ensure that the individualized plan of care reflected the goals of the planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 12: The patient elected the hospice benefit on 09/06/2024 with a hospice diagnosis of cerebrovascular disease. The Registered Nurse (RN) documented on 09/10/2024 that the patient was seeing huge bugs on her wall and was agitated and anxious, and Haldol 0.5mg was scheduled every 6 hours as needed for anxiety and agitation. In review of the plan of care for dates of 09/06/2024-12/19/2024, there was no evidence of a goal for the interventions for anxiety or agitation. Clinical Record 17: This patient elected the hospice benefit on 01/26/2024 with a terminal diagnosis of dysphagia following cerebral infarction. The comprehensive assessment dated 01/26/2024 stated the patient had a gastric tube for tube feeding. The order written on 01/26/2024 stated, gastric tube care to be completed daily by family or patient as follows, cleanse with saline daily with cotton tip applicator around gastric tube site. Place the split gauze and change daily with care. In review of the plan of care for the dates of 01/26/2024 through 02/05/2024, there was no evidence of a goals for the interventions for care of the gastric tube. The Director of Nursing was interviewed 12/19/2024 and confirmed that the above plans of care did not include all of the goals for the services provided to meet the needs of the patients.”