Paramount Hospice and Palliative Care

“Based on employee interviews (EMP) and reviews of agency policy, patient admission packets, and clinical records (CR) the agency failed to provide patients and patient representative/families with a copy of the hospices written policies and procedures on the management and disposal of controlled drugs for one (1) of ten (10) CRs reviewed. (CR 5) Findings included: A review of the agency document Patient Admission Handbook on 2/26/24 at approximately 10:00 am revealed patient teaching...”...How to Manage Medications at Home...Do...Non-Controlled Substances: dispose of all medications by dissolving agent...Consult the FDA-approved list of medicines that are considered safe to flush... Contact ...for the location of take back events or pharmacy drop boxes. ...” A review of agency clinical policies on 2/26/24 at approximately 1:00 pm revealed: Agency policy titled Safe Drug Disposal Procedure, effective 11/14/17, read: “;2. In a long-term care facility setting, hospice employees will dispose of controlled substances with the facilities nursing staff by... 3. In the home, the hospice staff will encourage the patient and/or designated caregiver to dispose of medications (including controlled substances) that are no longer ordered, due to discontinued use or death of the patient. ... 4. Hospice staff are responsible for the education of patients and families regarding the proper medication disposal methods. ...” Agency policy titled Narcotic Destruction, effective 5/1/08, read: “;Standard: It is the hospice nurses ethical responsibility to inform/assist the patient/caregiver of their responsibility in disposing of narcotics. Procedure: ...2. If the patient resides in a facility, the medications are to be disposed of in accordance with the facilitys policies and procedures. 3. If a hospice nurse, with patients/caregivers approval, participates in the disposal of medication, the method of disposal and amount disposed is documented and cosigned with a witness on the Narcotic Destruction Form and placed in the hospice medical record. Only licensed hospice staff will participate in medication destruction.” A Clinical record (CR) review was conducted on 2/28/24 between approximately 10:00 to 1:00 pm: CR5: Start of Care (SOC): 12/28/23, Certification Period Reviewed (Cert): 12/28/23 – 3/26/24. CR contained a Plan of Care dated 12/28/23 which contained orders for controlled substances with a start date of 12/28/23. CR contained no evidence that a written policy/procedure on the management and disposal of controlled drugs was provided to the patient or patient family/representative at the time that controlled substances were ordered on 12/28/23. During an interview with EMP1 (Administrator) on 2/28/24 at approximately 2:00 pm it was determined that the hospice agency did not provide copies of the hospices written policies and procedures on the management and disposal of controlled drugs to patients or patient representative/families. EMP1 verified that the information within the Patient Admission Handbook was the only document provided to all patients and patient family/representatives to review the management and disposal of controlled drugs. The above finding was reviewed during an exit conference on 2/28/24 at approximately 2:45 pm with EMP1 (Administrator), EMP2 (Project Manager), and EMP3 (Alternate Administrator).”

“Based on a review of inpatient agreements (AG) and interviews with staff (EMP) it was determined that the hospice agency failed to maintain training materials and verification of training for personnel within contracted inpatient facilities for one (1) of one (1) inpatient agreements reviewed. (AG1) Findings included: A review on 2/28/24 at approximately 2:00 pm of agency agreements revealed: AG1: Entry date: 5/6/21. Titled Inpatient and Respite Care Service Agreement revealed: “;3. Services and Responsibilities of Hospice...3.5 Nursing Facility Orientation. Hospice personnel must assure orientation of Nursing facility staff furnishing care to Hospice Patients in the hospice philosophy, including Hospice policies and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death and dying, individual responses to death, patient rights, appropriate forms, and record keeping requirements. ...” During an interview on 2/28/24 at approximately 2:00 pm with EMP1 (Administrator) it was determined that a roster of trained individuals and the training program/materials for AG1 were not available for review. The above finding was reviewed during an exit conference on 2/28/24 at approximately 2:45 pm with EMP1 (Administrator), EMP2 (Project Manager), and EMP3 (Alternate Administrator).”