Echo Hospice of Cleveland LLC

“Upon patient record review, 9 of 14 (Patients #2,3,4,5,6,7,8,9,10) 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. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Additionally, during medication reconciliation at the SNF, the following medications were not on the SNF medication profile but were on the hospice medication profile: Amlodipine 10mg QD, ASA 81mg QD, Lorazepam 0.5mg 1-4 tabs Q1hr PRN, Ketoprofen 5% QD, Betadine TID. The SNF medication profile had Incruse Ellipta 62.5 mcg QD and Linzess 72 mcg QD but was not included on Hospice medication profile Patient #3: This patient is prescribed Acetaminophen 325mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #4,5: This patient is prescribed Acetaminophen 325mg 2 tablets every 4 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #6: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed, Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed and Hydrocodone/Acetaminophen 5/325 one tablet 4 times daily as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #7: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #8: This patient is prescribed Acetaminophen 500mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #9: This patient is prescribed Acetaminophen 500mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours. Patient #10: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The medication profile did not specify a maximum dose of acetaminophen within 24 hours.”

“Upon patient record review, 3 of 14 (Patients #3,4,6) 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 #3: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Metformin 500 mg BID and Glucagon Emergency Kit-1 hypoglycemia IM Q24 hours. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated. Patient #4: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Lantus 22 units at bedtime and Humalog per sliding scale. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated. Patient #6: The patient record showed evidence that the patient is a diabetic. The medication profile indicates patient has Insulin Glargine 33 units daily. There was no evidence of problems, goals, or interventions related to the endocrine system. Corrected on site. Care plan updated.”

“Upon patient record review, 9 of 14 (Patients #2,3,4,5,6,7,8,9,10) 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 #2: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #3: This patient is prescribed Acetaminophen 325mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #4,5: This patient is prescribed Acetaminophen 325mg 2 tablets every 4 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #6: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed, Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed and Hydrocodone/Acetaminophen 5/325 one tablet 4 times daily as needed.. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #7: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #8: This patient is prescribed Acetaminophen 500mg 2 tablets every 8 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #9: This patient is prescribed Acetaminophen 500mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 6 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours. Patient #10: This patient is prescribed Acetaminophen 325mg 2 tablets every 6 hours as needed and Acetaminophen 650mg Suppositories 1 suppository every 4 hours as needed. The Plan of Care did not specify a maximum dose of acetaminophen within 24 hours.”