Grand View Hospice

“Based on review of clinical records (CR), hospice policies, hospice pharmacy agreement, and staff interviews, the hospice failed to ensure that the patient had the appropriate medications available to manage the patients symptoms for one (1) of twenty-two (22) CR reviewed. (CR #20). Based on review of clinical records, hospice policies, hospice on-call logs, and staff interviews, the hospice failed to ensure that after-hours calls were addressed in a timely manner for one (1) of twenty-two (22) CR reviewed. (CR #20). Findings include: Review of Hospice policy titled “;Hospice Admission Orders/Protocol, and Admission Medication Record (Paper downtime)” on June 27, 2024, at approximately 4:30 P.M. states, “;Policy: B. Comfort Medication and Emergency Kit Orders: Patients primary physician or the Hospice Medical Director will review all medications listed as Comfort. 1. Emergency Kit Use: a. The Hospice Medical Director may write any emergency narcotic prescription for home patients... D. Record Follow-up: 1. Admission protocol, Comfort Medication and Emergency Kit order, and Admission Medication Record will be mailed or faxed to the patients primary physician for signature...” Review of the Hospice “;Pharmacy Services Agreement Between Grand View Hospital and OP Pharmacy, LLC” on June 27, 2024, at approximately 5:00 P.M. states, “;Article 2 Service Fees: 2.1 Pricing: f. OPPC;s standard pharmacy hours are Monday – Friday 10:00 am- 6:00 pm, Saturday and Sunday 12:00 pm – 4:00 pm (eastern time zone)(“;Standard Hours”). OPPCs business days are Monday – Friday (“;Business Day”). A Business Day does not include Saturday, Sunday, or holidays.... h. OPPC will establish, in consultation with Hospice, cut-off times for the ordering of new medication orders for Hospice patients... New orders received prior to the cut-off time will go on the next scheduled delivery run. New orders received after the last scheduled cut-off time established for that day, will be delivered the next day. If Hospice places a medication order after the last cut-off time and requires delivery of the mediation before the next scheduled delivery run, OPC will charge a non-standard delivery fee...” Review of hospice policy titled “;On-Call Responsibility” on June 27, 2024, at approximately 4:30 P.M. states, “;Procedure: 3. The on-call RN will contact the patient/family/caregiver to ascertain the nature of the call within 15 minutes and will decide whether the call requires a home visit or other action...” Review of three (3) patient CR with complaints was conducted on June 27, 2024, from approximately 1:00 P.M. to 4:00 P.M., and nineteen (19) additional patient CRs reviewed as part of the State re-licensure and Medicare recertification surveys on June 24, 2024, from approximately 1:30 P.M. to 4:30 P.M., June 26, 2024, from approximately 4:00 P.M. to 6:00 P.M. and June 27, 2024, from approximately 7:00 A.M. to 8:00 A.M. and 9:00 A.M. to 4:00 P.M. revealed the following: CR #20, hospice benefit election date June 19, 2024. The certification period reviewed was June 19, 2024, through June 22, 2024. The patient was provided with a comfort kit the day after admission. The patient as transferred to an Assisted Living Facility (ALF) on June 21, 2024. The facility required pre-drawn syringes for the comfort kit medications, which were not available through the facility pharmacy. The new attending physician was contacted to sign the verbal order for the comfort kit medications, but declined. The hospice Medical Director was contacted by the hospice RN and the order was placed too late for same day delivery. The hospice was informed by the Director of Nursing (DON) at the facility that the family could bring in the medication from home and administer the medication, but the ALF is only permitted to administer pre-drawn medications in the amount and dosage ordered. Medication was ordered in pill form that required the family to pick up at the local pharmacy and deliver to the ALF. It is unclear if the medication was ever picked up and delivered to the ALF, or if an attempt was made to medicate the patient. The hospice-contracted pharmacy has an emergency delivery available but was not used due to the patient determined to be able to take medication in a pill form. There was no documentation that the patient received the medication to manage their extreme agitation and anxiety, resulting in the patient being admitted to the hospital for symptom management. Review of “;Call Logs” on June 27, 2024, at approximately 5:00 P.M. revealed a call was received on June 20, 2024, at 4:08 A.M. The on-call registered nurse (RN) documented on that a call was received that the patient was restless, combative and a visit was made. A communication note dated June 20, 2024, stated that a call received at 6:46 A.M. from the patients family stating that the patient is out of control, too weak to get up and walk, and is very restless. The family member was instructed to give medications from the comfort kit. The RN visit did not occur until 12:52 P.M. An interview with the Hospice Manager on June 27, 2024, at approximately 6:00 P.M. confirmed the above findings. Findings include: Review of Hospice policy titled “;Hospice Admission Orders/Protocol, and Admission Medication Record (Paper downtime)” on June 27, 2024, at approximately 4:30 P.M. states, “;Policy: B. Comfort Medication and Emergency Kit Orders: Patients primary physician or the Hospice Medical Director will review all medications listed as Comfort. 1. Emergency Kit Use: a. The Hospice Medical Director may write any emergency narcotic prescription for home patients... D. Record Follow-up: 1. Admission protocol, Comfort Medication and Emergency Kit order, and Admission Medication Record will be mailed or faxed to the patients primary physician for signature...” Review of the Hospice “;Pharmacy Services Agreement Between Grand View Hospital and OP Pharmacy, LLC” on June 27, 2024, at approximately 5:00 P.M. states, “;Article 2 Service Fees: 2.1 Pricing: f. OPPC;s standard pharmacy hours are Monday – Friday 10:00 am- 6:00 pm, Saturday and Sunday 12:00 pm – 4:00 pm (eastern time zone)(“;Standard Hours”). OPPCs business days are Monday – Friday (“;Business Day”). A Business Day does not include Saturday, Sunday, or holidays.... h. OPPC will establish, in consultation with Hospice, cut-off times for the ordering of new medication orders for Hospice patients... New orders received prior to the cut-off time will go on the next scheduled delivery run. New orders received after the last scheduled cut-off time established for that day, will be delivered the next day. If Hospice places a medication order after the last cut-off time and requires delivery of the mediation before the next scheduled delivery run, OPC will charge a non-standard delivery fee...” Review of hospice policy titled “;On-Call Responsibility” on June 27, 2024, at approximately 4:30 P.M. states, “;Procedure: 3. The on-call RN will contact the patient/family/caregiver to ascertain the nature of the call within 15 minutes and will decide whether the call requires a home visit or other action...” Review of three (3) patient CR with complaints was conducted on June 27, 2024, from approximately 1:00 P.M. to 4:00 P.M., and nineteen (19) additional patient CRs reviewed as part of the State re-licensure and Medicare recertification surveys on June 24, 2024, from approximately 1:30 P.M. to 4:30 P.M., June 26, 2024, from approximately 4:00 P.M. to 6:00 P.M. and June 27, 2024, from approximately 7:00 A.M. to 8:00 A.M. and 9:00 A.M. to 4:00 P.M. revealed the following: CR #20, hospice benefit election date June 19, 2024. The certification period reviewed was June 19, 2024, through June 22, 2024. The patient was provided with a comfort kit the day after admission. The patient as transferred to an Assisted Living Facility (ALF) on June 21, 2024. The facility required pre-drawn syringes for the comfort kit medications, which were not available through the facility pharmacy. The new attending physician was contacted to sign the verbal order for the comfort kit medications, but declined. The hospice Medical Director was contacted by the hospice RN and the order was placed too late for same day delivery. The hospice was informed by the Director of Nursing (DON) at the facility that the family could bring in the medication from home and administer the medication, but the ALF is only permitted to administer pre-drawn medications in the amount and dosage ordered. Medication was ordered in pill form that required the family to pick up at the local pharmacy and deliver to the ALF. It is unclear if the medication was ever picked up and delivered to the ALF, or if an attempt was made to medicate the patient. The hospice-contracted pharmacy has an emergency delivery available but was not used due to the patient determined to be able to take medication in a pill form. There was no documentation that the patient received the medication to manage their extreme agitation and anxiety, resulting in the patient being admitted to the hospital for symptom management. Review of “;Call Logs” on June 27, 2024, at approximately 5:00 P.M. revealed a call was received on June 20, 2024, at 4:08 A.M. The on-call registered nurse (RN) documented on that a call was received that the patient was restless, combative and a visit was made. A communication note dated June 20, 2024, stated that a call received at 6:46 A.M. from the patients family stating that the patient is out of control, too weak to get up and walk, and is very restless. The family member was instructed to give medications from the comfort kit. The RN visit did not occur until 12:52 P.M. An interview with the Hospice Manager on June 27, 2024, at approximately 6:00 P.M. confirmed the above findings.”