Heartland Hospice (Shawnee)

“Upon patient record review, 2 of 19 records (Patient #7, 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 #7: Phenytoin, Albuterol Aerosol, Carbamazepine, Lisinopril and Toprol were on the medication record of the hospice record but not the facility MAR. In addition Benzonatate, Ipratropium-Albuterol Nebulization and Pramipexole Dihydrochloride were on the facility MAR but not on the medication record of the hospice record. Corrected on site. Patient #10: The medication profile contained Potassium Chloride 20mEq oral packet BID. There was not evidence of a diluent. Corrected on site. In addition, Voltarin 1%, Docusate and ASA were on the hospice medication profile but not on the MAR at the facility. Also, Atorvastatin, Nasal saline gel, Eliquis, Freeze-it gel 3.5% Multi vitamins and Xyzal were on the facility MAR but not on the hospice medication profile. Corrected on site.”

“Upon patient record review, 1 of 19 records (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: The record indicated an assessment by the RN on 10/3/24. There was not evidence of an update until 10/24/24.”

“Upon patient record review, 4 of 19 records (Patient #7,#10,#13,#14) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #7: Benzonatate, Ipratropium-Albuterol Nebulization and Pramipexole Dihydrochloride were on the facility MAR but there was not evidence of an order on the hospice record. Corrected on site. Patient #10: The record contained an order for Potassium Chloride 20mEq oral packet BID. There was not evidence of a diluent. In addition, Atorvastatin, Nasal saline gel, Eliquis, Freeze-it gel 3.5% Multi vitamins and Xyzal were on the facility MAR but there was not evidence of an order on the hospice record. Corrected on site Patient #13: Nurse documentation dated 9/10/24 indicated that the patient had a suprapubic catheter that needed to be changed 2x in 1 week. The CTI dated 9/10/24 indicated that the suprapubic catheter got plugged yesterday. There was not evidence of an order to irrigate or change the catheter. Corrected on site. Patient #14: The record indicated a prn visit on 10/6/24 due to the caregiver stating that the patient’s BP was 90’s/40’s. Documentation indicated that the nurse advised to hold all BP medications and they were removed from the pill box. There was not evidence of an order from the physician to hold the BP medications.”

“Upon patient record review, 3 of 19 records (Patient #1,#12,#13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The record indicated a volunteer frequency was initiated on 10/4/24. There was not evidence of a visit. Patient #12: The social work visit frequency was 1m1, 2m2, 1m1 for the benefit period beginning 7/12/24. The record indicated only one visit in August and one visit in September. Patient #13: The visit frequency for the skilled nurse was 1w14. There was not evidence of a visit for the week of 10/13/24-10/19/24.”

“Upon patient record review, 1 of 19 records (Patient #12) 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, including alerts and precautions 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 Patient #12: The aide plan of care contained an alert/precaution for oxygen precautions. There was not evidence in the record that the patient was on oxygen. Corrected on site.”

“Upon patient record review 4 of 19 records (Patient #1,#2,#6,#7) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #1: The aide plan of care indicated for the task of shower weekly and shampoo the first visit of the week. Visit frequency was 3X/week. For the weeks beginning with 10/6/24, 10/13/24 and 10/30/24, documentation for the shower was with every visit and documentation for the shampoo was 2 times for the week of 10/6/24. Patient #2: The aide plan of care indicated for a shampoo to be performed at the second visit of the week. Visit frequency was 3x/week. For the week starting 9/15/24, the documentation revealed not needed at all 3 visits. For the weeks beginning 9/22/24 and 10/6/24, documentation revealed a shampoo was performed at 2 visits. For the weeks starting 9/29/24 and 10/13/24, a shampoo was performed at all visits. Patient #6: The aide plan of care indicated to provide shave and hair care the first visit of every week. Shave and hair care were performed at all visits in 3 of 4 weeks. Patient #7: Effective 8/14/24, the aide visit frequency was 2 aides 3x/week. On 10/14/24, 1 aide documented a shampoo was provided and the 2nd aide documented not needed. On 10/23/24 and 10/25/24, one aide documented yes to a shower and a bed bath and the second aide documented not needed.”

“Upon patient record review 1 of 19 records (Patient #13) did not have evidence of documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient #13: The record indicated that aides visited the patient 2x/week. There was not evidence of an aide supervisory visit between 10/3/24 and 10/24/24.”