Swan Hospice

“Upon patient record review, 1 of 20 (Patient #13) 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 #13: During patient visit to ALF, noted that facility hospice Rx profile has (effective 2/12/24) Morphine 20 mg/ml oral concentrate 20 mg/ml oral concentrate - Administer 0.25 ml 2 times a day for pain/sob. The Facility has the same Rx order, but with a frequency of 3x/day, effective 4/24/24.”

“Upon patient record review, 1 of 20 (Patient #11) 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 #11- SOC 1/19/24. Bereavement assessment for RN initial says not completed-Completed by social worker. Completed by chaplain. MSW initial assessment visit 1/30/24 (beyond 5 days) r/t patient request and no specific bereavement assessment identified in SC initial visit 1/22/24..”

“Upon patient record review, 4 of 20 (Patient #2, 4, 10, 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 #2: Patient admitted 4/8/24 with Gastrostomy/tube feedings. There no IDG POC problem(s) or goals/interventions related to gastrostomy, assessment, site care, feedings and no reference to coordinating with SNF. Patient #4: Admitted 3/12/24 with sacral wound. Care Plan includes Risk for impaired skin integrity, teach pressure relief measures, avoidance of friction only. No reference to existing wound and/or treatment and/or coordination with facility. Patient #10. Admitted 3/7/24 with Foley catheter. There are no related problem, goals interventions . Patient #13:ALF resident admitted 11/27/23 with indwelling 16 Fr 10 cc balloon Foley catheter. Goal to maintain patency, but no order for related interventions.”

“Upon patient record review, 2 of 20 (Patient #8,13) 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. Patient #8: Admitted 3/15/24 with melanoma nose. SN frequency initial POC 1wk13 and 10 prn. (1-10 prn for s/sx and death pronouncement). Patient #13 Admitted 11/27/24. SN 1wk4m and 4 prn. 3/29/24 SN 1wk1and 10 prn symptom management or death pronouncement. 10 prn visits is too broad and if needed would indicated frequency adjustment.”

“Upon patient record review, 4 of 20 (Patient #2,10,12,13) 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: SNF resident admitted with Foley catheter and gastrostomy tube for feedings. There are no orders related to catheter and gastrostomy. The IDG identifies problem of having catheter, but no orders specific to assessment, care, changes, maintenance, coordination of care for the SNF resident. Upon interview, it is reported that the facility manages catheter and gastrostomy. Education provided regarding coordinated Plan of Care. HA Care Plan includes Jevity 1.5 feeding-aspiration precautions at each visit and catheter care each visit, but no physician order included in record. Patient #10: 3/7/24 Tobramycin 0.3% ophthalmic ointment 0.3% ointment. Apply small film 3x/day for eye infection. Order does not specify which or both eyes. Patient has Foley catheter with no related orders to foley or who will provide care. Patient #12: SNF resident admitted 5/30/23 with indwelling catheter. IDG POC includes GU problem simply stated as indwelling catheter/drainage system patent and functioning without complication. There are no related orders documented in the record. Upon interview, SNF manages Foley. Education provided regarding coordinated Plan of Care. Patient #13:ALF resident admitted 11/27/23 with indwelling 16 Fr 10 cc balloon Foley catheter. Supplies included in orders however, not specific to foley and care. Patient also has Decubitus/Pressure Ulcer BL Buttocks with order to cleanse with NSS apply MediHoney with CA Alginate and cover with foam dressing 3x/week however, order is not specific to who will provide care.”

“Upon patient record review 2 of 20 (Patient #3, 5) 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 #3: Admitted 3/14/24 with HA Care Plan frequency of HA 5/wk. Task assignment for shampoo 2x/wk. HA documented shampoo was done daily: April 9, 10, 11, 12 (T-Fri). Patient #5: Admitted 3/8/24 with HA Care Plan frequency of HA 5/wk. Task assignment for shampoo 2x/week. HA documented shampoo was done daily April, 8, 9, 10, 11, 12. (M-F)”

“Upon patient client record review, 3 of 20 (Patient #11,12,20) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #11: The admission Informed Consent/Medicare Benefit Election and Designated Attending Physician Form has a hospice benefit effective date of 1/19/24. Both the wife/POA and witness signatures are dated 1/22/24, making the election date retroactive to signature. Patient #12: The admission Informed Consent/Medicare Benefit Election and Designated Attending Physician Form has a hospice benefit effective date of 5/20/24. Both the POA and witness signatures are dated 5/31/24, making the election date retroactive to signature. In addition, the section of Informed/Consent/Medicare Benefit Election and Designated Physician form is totally blank for space allocated to identify and confirm patient chose or declined to choose attending physician. Patient #20: The section of Informed/Consent/Medicare Benefit Election and Designated Physician form is totally blank for space allocated to identify and confirm patient chose or declined to choose attending physician.”

“Upon client record review, 4 of 20 (Patient #2, 4, 10, 12) 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: SNF resident admitted with Foley catheter and gastrostomy tube for feedings. There is no documented evidence of coordinated Plan of Care between the hospice and SNF (and patient) regarding catheter and gastrostomy. Patient #4: SNF Resident admitted 3/12/24 with wound care to sacral wound. There is no documented evidence of a coordinated Plan of Care between the hospice and SNF (and patient) regarding wound care. Patient #10: Patient has Foley catheter with no related orders/coordination of care. Patient #12: SNF resident admitted 5/30/23 with indwelling catheter. There is no documented evidence of coordinated Plan of Care between the hospice and SNF (and patient) regarding catheter.”