Angelic Hospice

“Upon patient record review, 2 of 27 (Patient #2, 15) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: 1/4/24 order Juven 7 gram-7 gram-1.5 gram oral powder packet oral 1 packet 2 times daily supplement. Start 1/3/24. Give 1 packet by mouth twice daily for supplement. The hospice medication profile does not include to dilute/reconstitute. Patient #15: During patient visit to ALF, there was discussion between RN and daughter and RN and Med Tech regarding patient’s 12.5 Fentanyl patch. The patch is not listed on hospice medication profile. Profile was updated before end of survey.”

“Upon patient record review, 2 of 27 (Patient #5, 7) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #5: 1/6/24 557 pm triage on call note. Received call from CG reporting extreme change in condition.... requesting nursing visit.... RN to initiate visit. There is no evidence of a follow up visit until 1/9/24. Documented patient comfortable and no reference to prior follow up concern or visit. Patient #7: 2/10/24 triage call r/t nebulizer “ends are frayed”...will do visit. Team made aware. There is no documented evidence of visit and/or follow up.”

“Upon patient record review, 7 of 27 (Patient #4, 5, 6, 7, 9, 14, 16) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients # 4, 5, 6. 7. 9, 14, 16: SC and MSW frequencies for 1/month and 6 PRN for additional support. The PRN frequency is too broad to meet the specific patient and family needs.”

“Upon patient record review, 2 of 27 (Patient #2, 15) 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 #2 ; 1/4/24 order Juven 7 gram-7 gram-1.5 gram oral powder packet oral 1 packet 2 times daily supplement. Start 1/3/24. Give 1 packet by mouth twice daily for supplement. The hospice order does not include to dilute/reconstitute. 1/4/24 Wound care orders for Sacral and left buttocks wound include Santyl 250 unit/gram topical ointment 1 application 2x daily to wounds left buttock sacrum-topically twice daily effective 1/3/24 and Calcium Alginate 4x4 bandage topical 1 application 2x daily. Dakin’s solution 0.25% topical,1 application 2x daily to wounds of sacrum and left buttock topically, effective 1/3/24. Facility record current includes Dakin’s solution only with fluffed gauze. RN states Calcium Alginate and Santyl were discontinued and hospice orders were not updated accordingly. The hospice orders were updated during visit. Patient #15: During patient visit and during medication review, hospice nurse discussed Fentanyl patch with med tech. Fentanyl was not included in hospice orders or med profile. It was confirmed that patient was using Fentanyl 12.5 mcg topically and changed q72 hrs. Hospice RN updated order 3/8/24.”

“Upon patient record review 2 of 27 (Patient #2, 3) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #2: SOC 1/3/24: 1/22/24 Assignment sheet. Pt weight every Monday and shampoo every Monday and Thursday. 2/12/24 (Monday) Patient weight and shampoo marked as “not due” Patient #3: SOC 1/5/24. HA 2xwk beginning 1/8/24. Only visits were 1/9 and 1/11/24. No documentation to clarify discontinuation of services. Orders/IDG POC not updated regarding frequency and reasoning.”

“Upon client record review, 1 of 27 (Patient #2) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #2: SOC 1/3/24. Patient admitted with sacral, buttocks wound requiring wound treatment. During patient visit, it was reported that the SNF consistently performs wound care. The hospice orders/POC do not clearly delineate responsibility to SNF nurse.”