Spero Hospice & Palliative Care

“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. 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 and interview. In 5 of 14 (36%) records reviewed the agency did not ensure that the drug profile contained all the patient’s current prescription and OTC drugs. Policy # A-6.0 Referral, Admission, Assessment and Establishment of the Plan of Care read in part, ‘3. B. vi. Medication profile that identifies all of the patient’s prescriptions, over the counter drugs, herbal remedies, and other alternative treatments, including oxygen. 4.E. The plan of care reflects the patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. F. iv. Drugs and treatment necessary to meet the needs of the patient.’ Clinical Record 1: The hospice election of benefit was dated 03/01/2023. The 02/24/2024 hospice plan of care for the 02/24/2024 hospice episode of care and the 03/06/2024 registered nurse assessment visit note documentation included the patient utilization of oxygen at 2lpm via nasal cannula. At the time of the review on 03/13/2024, oxygen was not included on the medication profile. Clinical Record 2: The medication profile read Colace 100 mg oral daily prn, Lorazepam 0,5mg oral prn, Ondansetron HCL 4 mg every 4 hours oral prn, Tramadol 50 mg oral every 8 hours prn. The most recent RN assessment was dated 03/03/2024. At the time of the review on 03/13/2024 the medications referenced did not include as needed qualifiers. Clinical Record 3: The medication profile read Bacitracin apply to right forearm one time per day and as needed. The most recent RN assessment was dated 02/26/2024. At the time of the review on 03/13/2024, the medication referenced did not include as needed qualifiers. Clinical Record 4: The medication profile read Naproxen Sodium 220mg oral bid prn. The most recent assessment was dated 02/26/2023. At the time of the review on 03/13/2024 the medication referenced did not include as needed qualifiers. Clinical Record 11: The hospice election of benefit was dated 02/16/2024. The 02/16/2024 hospice plan of care and the 02/16/2024 registered nurse assessment visit note documentation included the patient utilization of oxygen at 2-5lpm via nasal cannula. At the time of the review on 03/13/2024, oxygen was not included on the medication profile. During interview 03/15/2024, the Administrator reviewed the associated records and stated that the Oxygen and as needed qualifiers had inadvertently been omitted and had since been corrected.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary group and Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 10 (20%) records reviewed with the provision of aide services the agency did not ensure the hospice aide provided services as ordered by the Interdisciplinary group and Included in the plan of care. Clinical Record 8: The hospice election of benefit was dated 01/05/2024. The 01/13/2024 updated hospice aide plan of care created by the registered nurse, included a task frequency of linen change on Fridays. At the time of the review on 03/13/2024, the aide visit documentation included task completion on both Thursday 03/07/2024 and on Friday 03/08/2024 instead of on Fridays as assigned. Clinical Record 10: The hospice election of benefit was dated 02/01/2023. The 01/27/2024 hospice plan of care for the 01/27/2024 hospice episode of care include an aide frequency of 0 week 1, 3week. At the time of the review on 03/13/2024, there were only 2 aide visits documented for the week of 02/26/2023 dated 02/26/2024 and 03/01/2024 with no documented explanation of why care was not provided as per frequency ordered. During interview 03/14/2024, the Administrator stated that the care plan had not been followed and remedial education would be provided and also that a missed visit entry had since been entered for the missed frequency.”