Acg Hospice II

“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; and other alternative treatments that could affect drug therapy. 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, interview, and observation. In 3 of 19 (16%) clinical records reviewed and home visits observed, the agency did not ensure the patient’s drug profile was updated during each comprehensive assessment and/or when new medication was added or changes were made to existing medications. Clinical Record 1/Home Visit 1: During the home visit on 12/10/2024 with the Registered Nurse (RN) (Personnel Record 7), the hospice medication profile was compared to the patient’s medications. A bottle of Furosemide dated 11/14/2024 take 40mg daily was with the patient’s current medications and in the ‘med minder’ daily, confirmed by the daughter. The hospice medication profile reviewed on 12/09/2024 included Furosemide 20mg daily. The hospice medication profile did not include the 40mg daily. Clinical Record 10/Home Visit 2: During the home visit on 12/11/2024 with the Hospice Aide (Personnel Record 10), the hospice medication profile was compared to the facility medication list. The facility medication list included Vitamin B12 500mcg and Levetiracetam 1250mg twice a day. The hospice medication profile reviewed on 12/11/2024 included Diclofenac 1% gel as needed, Aspirin daily, and Levetiracetam 1,000mg twice a day. The hospice medication profile did not include Vitamin B12 500mcg and Levetiracetam 1,250mg twice a day. Clinical Record 2/Home Visit 3: During the home visit on 12/11/2024 with the Chaplain (Personnel Record 9), the hospice medication profile was compared to the patient’s medications. The patient presented her current medications, which included a bottle of Morphine dated 11/26/2024, take 0.25ml every 4 hours as needed for pain, and Trelegy 100mcg/62.5mcg/25mcg inhaler daily. The hospice medication profile reviewed on 12/10/2024 did not include Trelegy or Morphine. During a joint record review and interview on 12/11/2024, the Director of Operations agreed that the patient’s medication profile was not updated with the current medications. Additionally, the Director of Operations stated that we have a lot of new nurses and will be providing more education on visualizing the medications at the visits.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview, and observation. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure that the plan of care included drugs and treatment necessary to meet the needs of the patient. Clinical Record 1/Home Visit 1: During the home visit on 12/10/2024 with the Registered Nurse (RN) (Personnel Record 7), the hospice medication profile was compared to the patient’s medications. A bottle of Furosemide dated 11/14/2024, take 40mg daily, was with the patient’s current medications and in the med minder daily, confirmed by the daughter. The hospice medication profile reviewed on 12/10/2024 included Furosemide 20mg daily. It did not include the 40mg daily. The hospice plan of care reviewed on 12/10/2024 did not include the Furosemide. Clinical Record 2/Clinical Record 10: During the home visit on 12/11/2024 with the Chaplain (Personnel Record 9), the hospice medication profile was compared to the patient’s medications. The patient presented her current medications, which included a bottle of Morphine dated 11/26/2024, take 0.25ml every 4 hours as needed for pain, and Trelegy 100mcg/62.5mcg/25mcg inhaler daily. The hospice plan of care reviewed on 12/11/2024 did not include Trelegy or Morphine. Clinical Record 10: During the home visit on 12/11/2024 with the HHA, the hospice medication profile was compared to the facility medication list. The facility medication list included Vitamin B12 500mcg and Levetiracetam 1250mg twice a day. The hospice medication profile reviewed on 12/11/2024 included Diclofenac 1% gel as needed, Aspirin daily, and Levetiracetam 1,000mg twice a day. It did not include Vitamin B12 500mcg and Levetiracetam 1,250mg twice a day. The hospice plan of care reviewed on 12/11/2024 did not include Levetiracetam 1250mg twice a day and Vitamin B12 500mcg. During a joint record review and interview on 12/11/2024, the Director of Operations agreed that the plan of care did not include the medications identified.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met, as evidenced by document review, interview, and observation. In 2 of 4 (50%) home visit observations, the agency did not ensure the staff followed the hand hygiene policy. Agency Policy, Hand Hygiene Policy No. 7-011, stated in part, “Hand decontamination with an alcohol-based hand rub should be performed after contact with body fluids, or excretions, non-intact skin, wound dressings, after contact with inanimate objects in the immediate vicinity of the patient and after removing gloves. Hand washing with soap: Wash hands for at least fifteen (15) seconds, rinse with warm water, use a disposable towel to turn off faucet.” Home Visit 1: During the home visit on 12/10/2024 with the Registered Nurse (RN) (Personnel Record 7), the RN washed their hands with an alcohol-based hand rub, donned gloves, cut off kerlix gauze, removed gloves, donned new gloves, cleansed the wound, removed the dressing, put calcium alginate on the wound, secured with tape, put an ABD pad on wound and wrapped with kerlix, removed gloves, donned new gloves, and then dated the tape on the wound. The RN did not perform hand hygiene between the glove changes. Home Visit 2: During the home visit on 12/11/2024 with the Hospice Aide (Personnel Record 10), the aide washed their hands with soap and water, turned the faucet off with their hand, donned gloves, pulled phone from pocket, took picture of the coccyx, placed the phone on the recliner beside the patient’s bed, applied barrier cream. The aide did not turn the faucet off with a disposable towel, did not wash hands between glove changes, and did not wash their hands after touching the cell phone before touching the wound. During an interview on 12/12/2024, the Director of Clinical Operations confirmed the finding and the agency policy that hands should be cleansed between glove changes after touching inanimate objects, and the faucet should be turned off with a disposable towel.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group; Included in the plan of care. This standard was not met, as evidenced by clinical record review, interview, and observation. In 2 of 15 (13%) clinical records reviewed of patients who accepted hospice aide services, it was revealed that the agency did not ensure the hospice aide provided services as ordered and included in the plan of care. Clinical Record 5: The hospice aide plan of care dated 08/29/2023 ordered bathing (shower) three times a week. The patient was seen four times during the week of 09/04/2023, and a shower was documented as given each time. The patient was seen four times during the week of 09/25/2023 and was documented as receiving a shower each time. The patient was seen five times during the week of 10/02/2023, and a shower was documented as given each visit. Clinical Record 10/Home Visit 2: The hospice aide (Personnel Record 10) was observed during the visit, to the nursing facility, on 12/11/2024 transferring the patient from a high back wheelchair to the bath chair using a Hoyer lift and sling, showering the patient in the shower room, using an electric shaver to shave /trim eyebrows, electric nose hair trimmer, shaved face with razor. The hospice aide plan of care dated 10/19/2024 did not order the high back wheelchair or Hoyer lift using a sling, shower the patient in the shower room, use an electric shaver to shave /trim eyebrows, electric nose hair trimmer, or shave face with a razor. During a joint record review and interview on 12/11/2024, the Director of Operations agreed the hospice aide did not follow the plan of care as ordered. Additionally, the Director of Operations stated, more education is needed with the aides on following the plan of care.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The hospice documents the cost savings achieved through volunteers. Documentation includes: the identification of each position that is occupied by a volunteer; the work time spent by volunteers occupying those positions; estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions noted in Item 1 and for the durations noted in Item 2. This standard was not met as evidenced by document review and interview. The agency did not ensure that hospice volunteers provided administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The Hospice Volunteer Requirement Report reviewed for 01/01/2024 through 12/11/2024 revealed a volunteer cost savings of 2.82%. During a review of the Hospice Volunteer Requirement Report and interview on 12/12/2024, the Manager of Accreditation and Regulatory Compliance agreed that the agency did not meet the minimum five percent cost savings requirement for 2024.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: A copy of the hospice discharge summary; The patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed in which the patient was discharged due to moving out of the service area or is no longer terminally ill revealed that the agency did not ensure that the discharge summary was forwarded to the patient’s attending physician. Clinical Record 15: The patient elected the hospice benefit on 03/12/2024, and was discharged on 07/04/2024 (no longer terminally ill). There was no documented evidence that the discharge summary was provided to the patient’s attending physician. During a joint record review and interview on 12/12/2024, the Director of Patient Care Services agreed there was no documented evidence that the discharge summary was sent to the patient’s attending physician. Additionally, the Director of Operations stated, we need to educate the person responsible for sending them.”