Kindred Hospice

“Upon patient record review, 7 of 19 (Patients #1,#2,#3,#5,#7.#10,#12) 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. Patient 1: The medication profile contained Maalox scheduled every 4 hours in error instead of as needed. The profile also contained duplicative Oxycodone listings with 5mg and 10mg every 6 hours as needed with no instructions for different indications to determine appropriateness of administration of the different doses. Corrected on site. Patient 2: The medication profile contained duplicative Levsin listings with the same dose and frequency dated 5/25/23 and 8/31/23. Corrected on site. Patient 3: The medication profile contained duplicative Prazosin listings with differing doses at bedtime, with no further instructions if to be taken together or potential error. The profile also contained duplicative Keppra 1000mg listings with instructions to administer 1.5 tablets daily and 1 tab at bedtime. There were no instructions to specify whether to be given at different times of day or to be taken together. Corrected on site. Patient 5: The medication profile contained Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 7: The medication profile contained oxygen with no delivery method. Corrected on site. Patient 10: The medication profile contained nystatin topical powder with no defined area for administration. Corrected on site. Patient 12: The medication profile contained gabapentin 300mg daily and 400 mg at bedtime. There were no instructions to specify whether to be given at different times of day or to be taken together. Corrected on site.”

“Upon patient record review, 3 of 19 (Patients #1,#8,#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 1: The medical record contained an initial bereavement assessment 11/6/23 with a start of care 10/31/23. Patient 8: The medical record contained an initial bereavement assessment 9/22/23 with a start of care 9/14/23. Patient 11: The medical record contained an initial bereavement assessment 10/13/23 with a start of care 10/7/23.”

“Upon patient record review, 1 of 19 (Patient #13) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 13: There was no evidence of RN visits between 9/8/23 and 9/27/23, and between 9/27/23 and 10/14/23.”

“Upon patient record review, 6 of 19 (Patients #1,#3,#5,#7,#10,#12) 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: The medical record contained an order for Maalox scheduled every 4 hours instead of as needed. Corrected on site. Patient 3: The medical record contained duplicative Keppra orders with daily and bedtime doses without instructions whether to be taken together or separate times. Corrected on site. Patient 5: The medical record contained an order for Miralax oral powder with no instructions for a diluent. Corrected on site. Patient 7: The medical record contained an order for oxygen with no delivery method. Corrected on site. Patient 10: The medical record contained an order for nystatin topical powder with no defined area for administration. Corrected on site. Patient 12: The medical record contained duplicative gabapentin orders with daily and bedtime doses without instructions whether to be taken together or separate times. Corrected on site.”

“Upon patient record review, 4 of 19 (Patients #1,#2,#10,#14) 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 upon admission identifying patient use of a hospital bed and low air loss mattress. There was no evidence of the bed and mattress included as DME in the plan of care. Corrected on site. Patient 2: The medical record contained nursing documentation upon recertification identifying patient use of a bedside commode and Broda chair. There was no evidence of the commode and chair included as DME in the plan of care. Corrected on site. Patient 10: The medical record contained nursing documentation 10/12/23 identifying patient use of a Broda chair. There was no evidence of the chair included as DME in the plan of care. Corrected on site. Patient 14: The medical record contained nursing documentation identifying patient use of a scoop mattress since admission and a Hoyer lift since 10/25/23. There was no evidence of the mattress and lift included as DME in the plan of care. Corrected on site.”

“Upon patient record review, 2 of 19 (Patients #2,#14) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 2: The aide care plan contained a task for stand by assist with walker for ambulation. The medical record contained RN documentation since 10/11/23 identifying patient could no longer safely ambulate. Corrected on site. Patient 14: The medical record contained RN documentation identifying patient is a Hoyer lift for transfers. The aide care plan did not contain instructions for transfer with mechanical lift. Corrected on site.”

“Upon patient record review 3 of 19 (Patients #4,#5,#8) 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 4: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of aide visits completed the week of 10/15/23. Corrected on site with late entry for missed visit explanation. Patient 5: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of a second aide visit completed the weeks of 9/24/23 and 10/15/23. Corrected on site with late entry for missed visit explanation. Patient 8: The medical record contained an ordered aide frequency of twice weekly. There was no evidence of a second aide visit completed the weeks of 10/15/23 and 10/22/23. Corrected on site with late entry for missed visit explanation. The record also contained aide documentation 10/22/23 stating the patient’s chin was shaved. There was no evidence of a task for shaving on the aide care plan. Corrected on site.”

“Upon client record review, 2 of 19 (Patients #1,#7) 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 1: The medical record contained urostomy care orders that did not specify if nursing facility or hospice nursing is responsible for the weekly site cares and daily bag drainage. Corrected on site. Patient 7: The medical record contained an order for an indwelling catheter that did not specify if nursing facility or hospice nursing is responsible for catheter changes. Corrected on site.”