Constellation Hospice

“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; supplements; herbal remedies; other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: The effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. 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 4 of 15 (27%) clinical records reviewed revealed that the agency did not ensure that all of the patient’s current medications were included in the drug profile. Document 1: Agency Policy 2-004 “Medication Profile” dated 11/2023 read in part “Patients receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. The medication profiles will be updated for each change to reflect current medications, and new or discontinued medications. Upon admission to hospice, the admitting nurse will initiate a medication profile.”. Clinical Record 1: The start of care comprehensive assessment was 07/13/2024. The record revealed a physician’s order dated 07/13/2024 that read “Oxygen 2-4 liters via nasal cannula as needed for shortness of breath.”. The drug profile dated 07/13/2024 did not include oxygen. Clinical Record 2: The start of care comprehensive assessment was 05/30/2024. The record revealed a physician’s order dated 05/30/2024 that read “Oxygen 2-4 liters via nasal cannula as needed for comfort.”. The drug profile dated 05/30/2024 did not include oxygen. Clinical Record 5: The start of care comprehensive assessment was 01/21/2023. The record revealed a physician’s order dated 01/21/2023 that read “Oxygen 2 liters via nasal cannula continuously.”. The drug profile dated 01/21/2023 did not include oxygen. Clinical Record 9: The start of care comprehensive assessment was 12/09/2021. The record revealed an initial nursing assessment dated 12/09/2021 that read in part “Patient is using oxygen as needed for shortness of breath.”. The drug profile dated 12/09/2021 did not include oxygen. In an interview on 07/17/2024, the Administrator reviewed the records and stated, “There is not oxygen on these medication profiles”.”

“It is required that each patient’s individualized written plan of care Reflects patient and family goals; Identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; Includes all services necessary for the palliation and management of the terminal illness, including the following: Intervention to manage pain and symptoms; A detailed statement of the scope and frequency of services necessary to meet specific patient and family needs; Measurable outcomes anticipated from implementing and coordinating the plan of care; Drugs and treatment necessary to meet the needs of the patient; Medical supplies and appliances necessary to meet the needs of the patient; Includes the Interdisciplinary Group’s documentation of the patient’s or representative’s level of understanding, involvement, and agreement with the POC; The documentation in the patient’s record is in accordance with the hospice’s policies and procedure. This standard was not met as evidenced by clinical record review and interview. In 1 of 15 (7%) clinical records reviewed revealed that the agency did not ensure that medical supplies and equipment necessary to meet the needs of the patient were included in the plan of care. Clinical Record 9: The record revealed an initial nursing assessment dated 12/09/2021 that read in part “Patient is using oxygen as needed for shortness of breath.”. The plan of care dated 12/09/2021-03/07/2022 lacked documentation of oxygen in the medical supplies/durable medical equipment section. In an interview on 07/17/2024, the Administrator reviewed the record and stated, “There is no medical equipment listed on the plan of care.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 7 of 13 (54%) clinical records with aide services provided reviewed revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. Clinical Record 3: The record review revealed a physician’s order for oxygen dated 07/24/2022. The aide care plan dated 07/28/2022 lacked instructions related to oxygen. Clinical Record 4: The record review revealed a physician’s order dated 01/04/2023 that included wound care with a wound dressing for a wound to the sacrum. The aide care plan dated 01/06/2023 lacked instructions related to the wound dressing. Clinical Record 5: The record review revealed a physician’s order dated 01/21/2023 that included wound care with a wound dressing for a wound to the sacrum, orders for oxygen, and orders for a suprapubic catheter. The aide care plan dated 01/23/2023 lacked instructions related to oxygen, catheter care and the wound dressing. Clinical Record 6: The record review revealed a physician’s order dated 03/28/2023 that included wound care with a wound dressing for a wound to the sacrum and orders for a foley catheter. The aide care plan dated 03/28/2023 lacked instructions related to catheter care and the wound dressing. Clinical Record 11: The record review revealed a physician’s order dated 03/11/2022 that included orders for wound care and wound dressing to a wound on the left heel. The aide care plan dated 03/11/2022 lacked instructions related to the wound dressing. Clinical Record 13: The record review revealed a physician’s order dated 01/08/2022 that included wound care with a wound dressing to a wound on the left leg. The aide care plan dated 01/08/2022 lacked instructions related to the wound dressing. Clinical Record 15: The record review revealed a physician’s order for oxygen dated 04/11/2022. The aide care plan dated 04/26/2022 lacked instructions related to oxygen. On 07/17/2024 the Administrator reviewed the records and confirmed the findings that the aide care plans did not include specific instructions.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. In 1 of 13 (8%) clinical records with aide services provided review revealed that the agency did not ensure that aide services were provided as written in the plan of care. Clinical Record 8: The record revealed a physician’s order dated 01/05/2022 that read “Aide services 3 times per week.”. During the week of 01/30/2022-02/05/2022 the record revealed one aide visit dated 02/01/2022 with two visits outstanding. The record lacked missed visit notes for the two outstanding aide visits. In an interview on 07/17/2024, the Administrator reviewed the record and stated, “There are no missed visit notes in the patient chart.”.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 15 (13%) clinical records reviewed revealed that the agency did not ensure that all physician orders were included in the patient’s clinical record. Clinical Record 1: The record review revealed a physician’s order dated 07/13/2024 that read “Urinary catheterization PRN.”. The record lacked specific physician’s orders for the indication, size and maintenance of the urinary catheter. Clinical Record 9: The record review revealed an initial nursing assessment dated 12/09/2021 that read in part “Patient is using oxygen as needed for shortness of breath.”. The record lacked specific physician’s orders for oxygen. In an interview on 07/17/2024, the Administrator reviewed the records and stated, “There are not specific orders in these patient charts for oxygen or the size and maintenance of the catheter.””