Heartland Hospice (Cincinnati)

“Upon patient record review, 3 of 14 (Patients #1,#8,#9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile contained haloperidol and Metamucil PRNs that were not on the hospice profile. Corrected on site with orders received and medication profile updated. Patient 8: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility medication profile contains bowel protocol of step 1 give 3 oz prune juice if no BM in 2 days, step 2 give Miralax if no BM in 3 days, step 3 bisacodyl suppository if no BM in 8 hours, step 4 fleets enema if no results in 8 hours, step 5 repeat fleets enema and notify physician. The facility profile also contained acetaminophen 325mg tabs, give 3 tabs three times daily for fever/pain, latanoprost ophthalmic solution 1 drop both eyes at bedtime, an additional melatonin 3mg tab give 3 tabs at dinnertime, and senna 8.6mg give 2 tabs PRN. Corrected on site with orders received and medication profile updated. Patient 9: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility med profile contains breo ellipta inhaler daily, hydrocortisone topical cream twice daily, lorazepam concentrate 0.25ml every 4 hours PRN, all listed were discontinued by hospice orders previously and no longer on hospice profile. The facility profile contained an albuterol inhaler instead of nebulizer on hospice, and the facility did not contain the morphine and ativan PRNs that are on the hospice profile. Corrected on site with order clarifications and providing the medication orders to the facility.”

“Upon patient record review, 2 of 14 (Patients #1,#9) 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 1: The record identified patient was on hospice services for Alzheimer’s disease. There was no evidence of problems, goals, and interventions related to neurological disorder. The plan of care also contained inaccurate goals and interventions related to oxygen safety when the patient did not have oxygen. Corrected on site with plan of care update. Patient 9: The plan of care contained inaccurate goals and interventions related to oxygen safety when the patient did not have oxygen. Corrected on site with plan of care update.”

“Upon patient record review, 3 of 14 (Patients #1,#4,#8) 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 1: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility profile contained haloperidol and Metamucil PRN orders that the hospice did not have. Patient 4: The medical record contained nursing documentation 7/29/25 identifying patient use of oxygen and the record also contained an order for oxygen supplies. There was no evidence of an order for oxygen rate, frequency, and delivery method. Corrected on site with order clarification. Patient 8: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility had bowel protocol orders of step 1 give 3 oz prune juice if no BM in 2 days, step 2 give Miralax if no BM in 3 days, step 3 bisacodyl suppository if no BM in 8 hours, step 4 Fleets enema if no results in 8 hours, step 5 repeat Fleets enema and notify physician. The facility also had orders for acetaminophen 325mg tabs, give 3 tabs three times daily for fever/pain, latanoprost ophthalmic solution 1 drop both eyes at bedtime, an additional melatonin 3mg tab give 3 tabs at dinnertime, and senna 8.6mg give 2 tabs PRN. Corrected on site with orders received and medication profile updated.”

“Upon patient record review, 2 of 14 (Patients #1,#9) 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 equipment and supply needs. Patient 1: The medical record contained nursing documentation 5/27/25 identifying patient use of full bedrails. There was no evidence of an order for the DME included in the plan of care. Corrected on site with order received. Patient 9: The medical record contained nursing documentation upon admission identifying patient use of bed rails. There was no evidence of an order for the DME included in the plan of care. Corrected on site with order received.”

“Upon patient record review, 1 of 14 (Patient #8) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice’s 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient 8: Upon observation during home visit, there was no evidence the facility had received names of hospice personnel involved with care, the CTIs for benefit periods two and three, the election form, and an updated plan of care since 7/23/25. Corrected on site with delivery of items to facility.”