MUSC Health Hospice Kershaw

“Upon patient record review, 2 of 19 (Patient #2,12) 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 2: Medication list contains order for diclofenac 1 percent with instructions: 1 unit PRN external/topical mild pain. There is no evidence of application site for this medication. Patient’s medication list contains order for oxygen with instructions: 2-4 liters daily, inhaled for COPD. There is no evidence of instruction for use of inhalation route in the medication list instructions. Medication list contains order for hydrocodone/acetaminophen 7.5-325mg/15ml containing instructions: one tablet/capsule every 4 hours PRN by mouth for moderate to severe pain. There is evidence of order discrepancy between type of medication ordered (tablet vs. capsule). COS Patient 12: Medication list contains order for flonase 50mcg/actuation with instructions: 2 sprays daily intranasal for seasonal allergies. There is no evidence of further instruction re: 2 sprays daily and if intended for each nostril. Medication list contains order for SalonPas topical patch 3-1-6-10 percent with instructions: apply to skin up to three times daily as needed for mild pain. Remove for 8 hours between doses. There is no evidence of application site for this order.”

“Upon patient record review, 4 of 19 (Patient #3,4,12,13) 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 3: Patient has physician’s order for Plavix 75mg PO daily. There is no evidence of bleeding precautions on the patient’s plan of care. Patient’s care plan has no evidence of bleeding precaution interventions. Patient has aspiration precaution interventions in care plans. There is no evidence of aspiration precautions on the patient’s plan of care. Patient has documentation in the medical record re: foley catheter. There is documentation as recent as 09/19/24 regarding catheter. There is no evidence of physician’s orders for foley catheter or foley catheter care in patient’s plan of care. COS Patient 4: Patient has physician’s order for Eliquis 2.5mg PO twice daily. There is no evidence of bleeding precautions on the patient’s plan of care. Patient’s care plan has no evidence of bleeding precaution interventions. Patient has aspiration precaution interventions in care plans. There is no evidence of aspiration precautions on the patient’s plan of care. COS Patient 12: Patient has physician’s order for Aspirin 81mg chewable tablet by mouth daily for blood thinner. There is no evidence of bleeding precautions on the patient’s plan of care. Patient’s care plan has no evidence of bleeding precaution interventions. Patient 13: Patient has seizure precaution interventions in care plans. There is no evidence of seizure precautions on the patient’s plan of care. COS”

“Upon patient record review, 2 of 19 (Patient #2,12) 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: Plan of care contains order for diclofenac 1 percent with instructions: 1 unit PRN external/topical mild pain. There is no evidence of application site for this medication. Patient’s Plan of care contains order for oxygen with instructions: 2-4 liters daily, inhaled for COPD. There is no evidence of instruction for use of inhalation device in the Plan of care instructions. Plan of care contains order for hydrocodone/acetaminophen 7.5-325mg/15ml containing instructions: one tablet/capsule every 4 hours PRN by mouth for moderate to severe pain. There is evidence of order discrepancy between type of medication ordered, i.e. liquid versus tablets. COS Patient 12: Plan of care contains order for flonase 50mcg/actuation with instructions: 2 sprays daily intranasal for seasonal allergies. There is no evidence of further instruction re: 2 sprays daily. Plan of care contains order for SalonPas topical patch 3-1-6-10percent with instructions: apply to skin up to three times daily as needed for mild pain. Remove for 8 hours between doses. There is no evidence of application site for this order.”

“Upon patient record review, 2 of 19 (Patient #6,7) 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 equipment and supply needs. Patient 6: Assessed DME need: walker, shower chair, bed, overbed table. DME on plan of care: cane, shower chair, bed, overbed table. There is no evidence of walker on the plan of care in DME needs. COS Patient 7: Assessed DME need: bedside commode, walker, wheelchair, bed. DME on plan of care: bedside commode, walker. There is no evidence of bed and wheelchair on plan of care in DME needs. There is evidence of wheelchair and hospital bed need located in the Safety care plans. COS”

“Upon patient record review, 5 of 19 (Patient #2,3,4,6,13) 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 2: Hospice aide assigned following tasks with frequency as PRN: shampoo; oral care; nail care; foot care; assist with dressing; incontinent care; barrier cream; reposition; housekeeping; change linen. COS Patient 3,4,13: Hospice aide was assigned the following task with frequency as PRN: change linen. COS Patient 6: Patient has a quad cane and this equipment is not listed on the aide plan of care as a DME need. COS”

“Upon patient record review 2 of 19 (Patient #2,5) 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 2: Physician order for aide visits is twice weekly. There is a documented missed aide visit on 07/01/2024 and 09/09/2024. There is no evidence of a second aide visit made during either of those weeks. COS Patient 5: Physician order for aide visits is 5 days per week. There is evidence of missed visits on 09/02/2024 and 09/04/2024. There is evidence of documented missed visits. The missed visit documentation is dated 09/03/2024 and 09/06/2024. There is no evidence of documentation that these notes are meant for other dates. COS”