Frontier Hospice

“Upon patient record review, 4 of 19 (Patient #1, 4, 6, 8) 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 1: There is documentation in nurses note written 5/8/24 that patient is wearing oxygen at 3LPM. Patient medication profile for oxygen states 2LPM via nasal cannula per profile written on 4/27/24. Patient medication profile for oxygen states 2LPM via nasal cannula per profile written on 5/2/24. There is no evidence of oxygen in medication profile with administration rate of 3LPM. Patient 4: 5/13/24 Cotisporin otic drops in medication profile. This medication is profiled as administration for ten days. This order is still active. Patient has artificial tears in medication profile. There is no evidence of administration site for this medication. Patient 6: Fluticanasone on medication profile states 2 sprays daily. There is no evidence of administration site for this profiled medication. There is no evidence of dilutant in profiled medication: Miralax. Patient 8: Profiled medication: Catapres Transdermal Patch 0.1mg/24 hours. Dose states 0.1 microgram. Frequency states twice daily. Route states mouth/throat. Special instructions list HTN/do not crush.”

“Upon patient record review, 3 of 19 (Patient #12, 13, 14) 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 12: Nurse visits made 5/16/24, 5/21/24, 5/23/24, 5/28/24, 5/30/24, 6/4/24, 6/6/24, 6/11/24. Only body system assessed was skin. Patient 13: Nurse visit made 5/7/24, only body systems assessed: neuro, skin, musculoskeletal, nutrition. Nurse visit made 5/10/24, body systems assessed: neurological, gastrointestinal, skin, nutrition. Nurse visit made 5/14/24, body systems assessed: neurological, respiratory, skin, nutrition. Nurse visits made 5/16/24 and 5/21/24, body systems assessed: neurological, gastrointestinal, skin, nutrition. Nurse visit made 5/23/24, body systems assessed: neurological, respiratory, gastrointestinal, skin, musculoskeletal. Nurse visit made 6/5/24, body systems assessed: neurological, gastrointestinal, skin, nutrition. Nurse visit made 6/7/24, body systems assessed: neurological, respiratory, skin, nutrition. Nurse visit made 6/11/24, body systems assessed: neurological, skin, musculoskeletal. Patient 14: Nurse visit made 5/7/24, only body systems assessed: cardiac, gastrointestinal, skin, urinary. Nurse visit made 5/10/24, body systems assessed: neurological, respiratory, cardiac, skin, urinary. Nurse visit made 5/13/24, body systems assessed: neurological, cardiac, gastrointestinal, skin. Nurse visit 5/21/24, body systems assessed: neurological, respiratory, cardiac, skin. Nurse visit 5/24/24, body systems assessed: respiratory, cardiac, skin, musculoskeletal. Nurse visit 5/29/24, body systems assessed: neurological, respiratory, cardiac, skin, urinary, musculoskeletal. Nurse visit 6/3/24, body systems assessed: respiratory, cardiac, skin, urinary. Nurse visit 6/6/24, body systems assessed: neurological, respiratory, cardiac, skin. Nurse visit 6/11/24, body systems assessed: neurological, cardiac, skin, musculoskeletal.”

“Upon patient record review, 4 of 19 (Patient #1, 3, 5, 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: Patient determined to be high risk for falls. There is no evidence of falls precautions on patient’s plan of care. Patient 3: Patient is taking daily aspirin. There is no evidence of bleeding precautions on patient’s plan of care. Patient 5: Patient is taking Eliquis. There is no evidence of bleeding precautions on patient’s plan of care. Patient 9: Patient is taking Keppra for seizures. There is no evidence of seizure precautions on patient’s plan of care.”

“Upon patient record review, 4 of 19 (Patient #1, 4, 6, 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: There is documentation on 5/8/24 that patient is wearing oxygen at 3LPM. Patient has order for oxygen that reads 2LPM via nasal cannula written on 4/27/24. Patient also has order for oxygen that reads 4LPM via nasal cannula written on 5/2/24. There is no evidence of oxygen order with administration rate of 3LPM. Patient 4: 5/13/24 order for cotisporin otic drops. Order states drops to be administered for ten days. This order is still active. Patient has an order for artificial tears. There is no evidence of administration site for this order. Patient 6: Order for Fluticanasone states 2 sprays daily. There is no evidence of administration site for this order. There is no evidence of dilutant in order for miralax. Patient 8: Medication order: Catapres Transdermal Patch 0.1mg/24 hours. Dose states 0.1 microgram. Frequency states twice daily. Route states mouth/throat. Special instructions list HTN/do not crush.”

“Upon client record review, 5 of 19 (Patient #1, 4, 5, 6, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: Spiritual care frequency is ordered twice monthly. There is evidence of only one spiritual care visit in May 2024. Patient 4: Spiritual care frequency order written 5/1/24 with an end date of 5/27/24. Frequency is ordered as twice monthly. There is evidence of only one spiritual care visit made in connection with this order. Visit date 5/7/24. Spiritual care frequency order written 5/28/24. Frequency is ordered as twice monthly. There is evidence of only one spiritual care visit made in connection with this order between 5/28/24 and 5/31/24. Visit date 5/28/24. Patient 5: Patient has wound care order written 6/3/24 for skin tear. Order reads: hospice nurse to cleanse with normal saline, apply steri strips, cover with opsite until hospice nurse removes. On 6/3/24 visit made by hospice nurse. Nurse documented wound care as cleansing skin tear, applying steri strips and covering with telfa and tape. Patient 6: Spiritual care frequency order written 5/30/24 with an end date of 8/27/24. Frequency is ordered as twice monthly. There is no evidence of a spiritual care visit made 5/30/24-6/1/24 in connection with this order. Patient 8: Spiritual care frequency order written 4/29/24. Frequency is ordered as monthly. There is no evidence of a spiritual care visit made in connection with this order between 4/29/24 and 5/1/24.”

“Upon patient record review, 6 of 19 (Patient #5, 9, 10, 11, 12, 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 5: Aide task shampoo is written with frequency of 3 times weekly. This task states per patient/caregiver request. Aide task max assist with toileting-no evidence of frequency. Patient 9: Patient is taking Keppra. No evidence of seizure precautions on aide care plan. Patient 10: Aide task nail clean and cut has frequency of PRN. Patient 11: Aide task range of motion has frequency of as tolerated. Patient 12: Aide task whirlpool bath has frequency of every visit. There is no task for dressing patient despite documentation in patient’s record indicating max assist. Patient 14: Plan of care states patient has need for electric razor and bleeding precautions. Aide care plan has no evidence of bleeding precautions or electric razor.”

“Upon patient record review 8 of 19 (Patient #4,7,8,9,10,11,12,14) 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: Aide task assist with urinal-frequency is every visit. This task is marked as not required/not completed since 5/9/24. Patient 7: Aide task blow dry hair is ordered every visit. This task was marked not required/not completed 5/24/24. Aide task change linen is ordered every visit. This task was marked not required/not completed 6/5/24. Patient 8: Aide task ensure oxygen in place at end of visit is ordered every visit. This task was marked not required/not completed on dates: 5/2/24, 5/7/24, 5/14/24, 5/20/24, 5/23/24, 6/6/24. Patient 9: Aide task shave is ordered every visit. This task was marked not required/not completed 5/1/24. Patient 10: Aide task apply lotion is ordered every visit. This task was marked not required/not completed 5/13/24. Aide task assist with ambulation using wheelchair is ordered every visit. This task was marked not required/not completed 5/21/24. Patient 11: Aide task complete bed bath is ordered twice weekly. This task was marked not required/not completed 6/7/24. Patient 12: Aide tasks shampoo, shave, apply lotion ordered every visit. These tasks marked not required/not completed 5/7/24. Aide task shampoo ordered every visit. This task was marked not required/not completed 6/10/24. Patient 14: Aide task shave is ordered every visit. This task was marked not required/not completed 5/21/24.”