High Peaks Hospice and Palliative Care, Inc.

“Based on clinical record review and staff interview the hospice failed to ensure in seven of sixteen records (Patient # 2, 3, 4, 5, 6, 14 and 18) an individualized and complete physician Plan of Care (POC) was developed to meet the needs of the patient. Failure to develop a patient specific individualized and complete plan of care has the potential to result in unmet patient needs and negative patient outcomes. Patient # 2 (start of care 12/11/2023) has diagnoses of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure. The Physician’s POC for certification period 12/08/2023 through 03/06/2023 contains an order for: Digoxin (Digox) 125 micrograms (mcg) (0.125 milligrams (mg)) oral tablet; Take 1 tablet (tab) orally once a day. The order is incomplete as it does not contain pulse parameters. Patient # 3 (start of care 03/01/2023) has diagnoses of Chronic Diastolic (Congestive) Heart Failure and Pericardial Effusion (Noninflammatory). The Physician’s POC for certification period 10/27/2023 through 12/25/2023 contains an order for: Aspirin Low Dose 81 mg oral delayed tablet 81 mg oral delayed release tablet. Take 1 tablet oral once a day (at bedtime). The POC is incomplete as it is lacking bleeding precautions related to the use of Aspirin. Patient # 4 (start of care 02/02/2023) has diagnoses of Muscular Dystrophy and Other Dermatomyositis Organ Involvement. The Physician’s POC for certification period 09/30/2023 through 11/28/2023 contains orders for: Skilled Nursing 3 times per week for 9 weeks (3 wk 9wk) (Beginning week of 10/02/2023 -Ending on 11/28/2023) and Skilled Nursing 1 wk 9 wk (Beginning week of 10/03/2023 -Ending on 11/28/2023). The orders require clarification of the frequency. Also, The Physician’s POC for certification period 11/29/2023 through 01/27/2023 contains orders for: Skilled Nursing 3 wk 8wk (Beginning week of 12/03/2023 -Ending on 01/27/2024) and Skilled Nursing 1 wk 8 wk (Beginning week of 12/04/2023 -Ending on 01/27/2024). The orders require clarification of the frequency. Patient # 5 (start of care 10/17/2023) has diagnoses of Cardiomyopathy, Unspecified and Atrial Fibrillation, Unspecified. The Physician’s POC for certification period 12/08/2023 through 03/06/2023 contains an order for: Digoxin 125 mcg (0.125 mg) oral tablet; Take 1 tablet (tab) orally once a day. The order is incomplete as it does not contain pulse parameters. Patient # 6 (start of care 08/03/2023) has diagnoses of Parkinson’s Disease and Unspecified Dementia, Unspecified Severity. The Physician’s POC’s for certification periods 08/03/2023 through 10/31/2023 and 12/08/2023 through 03/06/2023 contain an order for: Nitrostat 0.4 mg sublingual tablet. Take 1 tablet (tabs) sublingually every 5 minutes as needed for chest pain. The order is incomplete as it does not tell the patient how many times to take the medication before notifying the physician if pain persists. Patient # 14 (start of care 12/05/2023) has diagnoses of Squamous Cell Carcinoma of Skin of Scalp and Neck and Malignant Neoplasm of Tongue, Unspecified. The Physician’s POC’s for certification periods 12/08/2023 through 03/06/2023 and 08/03/2023 through 10/31/2023 contain orders for: Aspirin Low Dose 81 mg oral tablet; chewable; Chew 1 tab by gastrostomy tube once a day; Clopidogrel 75 mg oral tablet; Take 1 tab by gastrostomy tube once a day; Finasteride 5 mg oral tablet; Take 1 tab by gastrostomy tube once a day; Lasix 20 mg oral tablet; Take 1 tab once a day; Metformin 500 mg oral tablet; Take 1 tab by gastrostomy tube 2 times a day; Metoclopramide 5 mg oral tablet; Take 1 tab by gastrostomy tube every 6 hours as needed for nausea; Metoprolol Tartrate 25 mg oral tablet; Take 0.5 tab(s) by gastrostomy tube every 12 hours; MiraLax oral powder for reconstitution; Administer 17 gm(s) by gastrostomy tube every 12 hours as needed for constipation; Nexium 40 mg oral powder for reconstitution; delayed release; Administer 1 packet by gastrostomy tube once a day; Oxycodone 5mg/5 milliliter (ml) oral solution; take 5 milliliters by gastrostomy tube every 4 hours as needed for moderate pain; Probiotic Formula (Bacillus Coagulans) oral capsule; Take 1 cap by gastrostomy tube once a day; Spironolactone 25 mg oral tablet; Take 1 tab by gastrostomy tube once a day and Tylenol 325 mg oral capsule; Take 2 tab(s) by gastrostomy tube every 6 hours as needed for mild pain; Do not exceed 3 grams per day. The POC is incomplete as these orders are lacking specific instruction for gastrostomy tube medication administration: crush tablets/open capsules, mix with specific amounts of fluids and orders for before and after medication administration gastrostomy tube flushes and the following order requires clarification as to whether the medication is to be given orally (chewable) or gastrostomy tube: Aspirin Low Dose 81 mg oral tablet; chewable; Chew 1 tab by gastrostomy tube once a day; Also, the POC is incomplete as it is lacking fluid administration orders for hydration. Additionally, the POC is incomplete as it is lacking specific reconstitution directions for: MiraLax oral powder for reconstitution; Administer 17 gm(s) by gastrostomy tube every 12 hours as needed for constipation; Nexium 40 mg oral powder for reconstitution; delayed release; Administer 1 packet by gastrostomy tube once a day. Furthermore, the POC is lacking directions for what to do if the gastrostomy tube dislodges. Patient # 18 (start of care 09/29/2023) has diagnoses of Malignant Neoplasm of Unspecified Part of Left Bronchus or Lung and Neoplasm of Unspecified Behavior of Bone Soft Tissue and Skin. The Physician’s POC for certification period 09/29/2023 through 12/27/2023 contains an order for: MiraLax oral powder for reconstitution; Administer 17 grams (gm(s)) orally once a day as needed for constipation. The order is incomplete as it is lacking specific reconstitution instructions. The findings were confirmed on 12/12/2023 at 3:25 pm with the Administrator, Clinical Nurse Manager and Advanced Nurse Practitioner /Clinical Analyst, on 12/13/2023 at 1:15 pm and 3:15 pm with the Clinical Nurse Manager and Advanced Nurse Practitioner /Clinical Analyst and on 12/14/2023 at 10:15 am with the Advanced Nurse Practitioner /Clinical Analyst; no additional evidence was provided.”

“Based on staff interview the hospice failed to ensure orientation was provided to Skilled Nursing Facility (SNF) staff furnishing care to Hospice patients regarding the Hospice philosophy, Hospice policies and procedures regarding methods of comfort, pain control, symptom management, principles about death and dying, individual response to death, patient rights, appropriate forms and record keeping requirements. Failure to ensure SNF staff have received orientation, regarding the Hospice philosophy, Hospice policies and procedure regarding methods of comfort, pain control, symptom management, principles about death and dying, individual responses to death, patient rights, appropriate forms and record keeping requirements has the potential to result in the provision of inappropriate care, unmet patient and family needs and negative patient outcomes. Finding: The Director of Patient Services and Advanced Nurse Practitioner, Clinical Analyst were interviewed on 12/14/2023. A request was made for documentation of Skilled Nursing Facility (SNF) staff providing care to Hospice patients orientation to the Hospice philosophy, Hospice policies and procedures, appropriate forms and record keeping requirements. On 12/15/2023 at 11:00 AM, the Director of Patient Services stated they have attempted to orient SNF staff but have been unable to secure a date and time to do so. Therefore, the Hospice is lacking any documented evidence of SNF staff orientation. The finding was confirmed on 12/15/2023 at 11:00 AM with the Director of Patient Services and Advanced Nurse Practitioner, Clinical Analyst; no additional evidence was provided.”