Hospice of Charleston

“Upon patient record review, 3 of 19 (Patient #4, 6, 16) 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 4 order on 4/16/24 for Oxygen at 4LPM. Nursing visits 5/3, 5/7, 5/10 document oxygen at 2.5LPM. No evidence of Oxygen 2.5LPM on MAR. Patient 6 nursing visits April and May document Oxygen 2-4LPM, no evidence of Oxygen on the MAR. Patient 16 Ativan and Morphine on MAR with route as injection, does not specify IV. Patient has a PIV.”

“Upon patient record review, 5 of 19 (Patient #2, 6, 7, 10, 14) 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 2 care plan has problems, goals and interventions for spiritual care and there are no orders for spiritual care to see the patient. Patient 6 nursing visits in April and May document Oxygen in use at 2-4LPM, there is no care plan for oxygen use and safety. Patient 7 and 14 taking Eliquis, no evidence of bleeding precautions. Patient 10 initial nursing assessment documents aspiration precautions, no evidence of aspiration precautions on the care plan.”

“Upon patient record review, 4 of 19 (Patient #2, 4, 6, 16) 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 2 nursing notes April and May document the patient has a foley, no evidence of an order for the foley size, frequency and management. Patient 4 order on 4/16/24 for Oxygen at 3LPM. Nursing visits 5/3, 5/7, 5/10 document oxygen at 2.5LPM. No evidence of an order for Oxygen 2.5LPM. Patient 6 nursing visits April and May document Oxygen 2-4LPM, no evidence of an order for Oxygen. Patient 16 Ativan and Morphine ordered with the route as injection, does not specify IV. Patient has a PIV.”

“Upon client record review, 4 of 19 (Patient #1, 2, 3, 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 order on 2/19/24 for SW effective 2/20/24 2m2, 1m1 and 2 prn. Order on 2/21/24 for SC effective 2/20/24 1m3 and 2prn. No evidence of SW or SC visit from 2/20-2/29/24. Volunteer order 4/24/24 for companionship 1x month. Volunteer visit on 4/25/24 documented companionship, emotional/spiritual support, and socialization. Patient 2 volunteer assessment on 12/15/23 documented volunteer 1x month for caregiver relief and companionship. Volunteer note on 3/1/24 documented not a good time will try next week. No evidence of monthly visits, or follow up on volunteer needs. Patient 3 order on 4/10/24 for SW 1m2 and 2prn, SC 1m2, 1m1 and 2 prn effective 4/18/24. No evidence of SW or SC visit from 4/18/24-4/30/24. Volunteer ordered 5/2/23 2x month for caregiver relief. Volunteer visit on 1/25/24 documented caregiver relief and companionship, visit on 2/11/24 documented companionship and social support, visit on 3/30/24 documented companionship and no evidence of a second visit in March, visit on 4/24 documented companionship and socialization, and visit on 4/29 documented companionship and caregiver relief. Patient 13 order on 1/22/24 for SW 2m3 and 2 prn and for SC 2m2, 1m1 and 2prn both effective 1/23/24. No evidence of SW or SC visits from 1/23/24-1/31/24. SW visit completed 4/9/24 without an order and SC visit completed on 4/11/24 without an order.”

“Upon patient record review, 6 of 19 (Patient #4, 5, 7, 10, 13, 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 4 care plan includes aspiration precautions, no evidence of aspiration precautions on the aide care plan. Patient 5 incontinence care is listed as weekly and every visit, aide frequency is 2 times a week. Patient 7 taking Eliquis, no evidence of bleeding precautions on the aide care plan. Aide care plan has foley care and empty drainage bag every visit, no foley documented in nursing visits from 4/25/24 to current. Patient 10 initial nursing assessment documents aspiration precautions, no evidence of aspiration precautions on the aide care plan. Patient 13 aide care plan on 3/6/24 included shower and dressing the patient. Aide care plan on 5/9/24 included shower and did not include dressing the patient. Nursing documentation supports the patient needing assistance with dressing. Patient 14 taking Eliquis, no evidence of bleeding precautions on the aide care plan.”

“Upon patient record review 5 of 19 (Patient #1, 2, 5, 6, 7) 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 1 the 2/19/24 aide care plan has every task to be completed every visit. Aide visit on 4/24/24 documented oral care not needed this visit. Aide visits on 4/24, 5/1, 5/3, 5/8 documented for shower no sponge bath given and for shampoo not needed this visit. Aide visit on 5/10/24 for shower documented no sponge bath given, shampoo and linen change no, not needed this visit. Patient 2 aide care plan included change linen every visit. Aide visit on 4/19/24 documented no, not needed this visit. Patient 5 aide care plan included shampoo every visit. Aide visit on 5/2/24 documented shampoo yes and then a comment not needed this visit. Patient 6 aide care plan included shower and shampoo every visit. Aide visit on 4/27/24 for shower documented refused and washed at the sink, no evidence of calling the nurse to change the care plan. Aide visit on 5/2/24 for shampoo documented yes and a comment not needed this visit. Patient 7 aide care plan dated 4/29/24 included shampoo weekly. Shampoo was performed on the following aide visits 5/1/24, 5/4, 5/6, 5/8, 5/10.”

“Upon client record review, 3 of 19 (Patient #4, 5, 6) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 4 order on 3/20/24 for SW 1m2 and 2 prn and for SC 1m2 and 2prn effective 3/28/24. No evidence of visit for SW or SC in March 3/28 or after. Volunteer ordered 3/15/24 2x month for companionship and deliveries. Volunteer visits on 4/5 and 4/20 documented companionship, emotional/spiritual support, and socialization. Patient 5 order on 2/7/24 for SW 1m3 and 2prn and for SC 2m2, 1m1 and 2 prn, both effective 2/19/24. No evidence of SW or SC visits from 2/19-2/29/24. Volunteer ordered 2/7/24 2x month for companionship. Volunteer visits from 2/19/24-4/19/24 documented companionship and socialization. Patient 6 order on 4/17/24 for SW 2m2 and 2 prn, for SC 2m2 effective 4/25/24. No evidence of SW or SC visits from 4/25/24-4/30/24.”