Edisto Home Care & Hospice

“Upon patient record review, 5 of 19 (Patient #3, #4, #5, #7, #9) 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 #3:The medication profile indicated to apply lidocaine patch 5% every 12 hours for pain. Instructions were lacking the location of where to place pain patch. Patient #4: The medication profile included MiraLAX 17gm daily as needed for constipation. The medication instruction lacks the quantity of liquid indicated for reconstitution prior to administration. Patient #5: The medication profile included MiraLAX 15gm as needed daily for constipation. This medication is dispensed as MiraLAX 17gm and the medication profile states MiraLAX 15gm. Also, the medication instruction lacks the quantity of liquid indicated for reconstitution prior to administration. Patient #7: The medication profile includes MiraLAX 17gm to administer 2 times a day for constipation. The mediation instruction lacks the quantity of liquid indicated for reconstitution prior to administration. Patient #9: The medication profile included Clonazepam 0.5mg, take 1/2 tablet ( 25 mg) by mouth 2 times a day and was inconsistent with the dosage on the facility MAR. Geri-Tussin 100mg/5ml to administer every 4 hours and was inconsistent with frequency of administration as indicated on the facility MAR.”

“Upon patient record review, 3 of 19 (Patient #7,#10,#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 #7: It is documented the patient is diabetic and requires daily oral medication and monitoring. There is not evidence the care plan was updated to include goals and interventions to monitor progress toward outcomes related to diabetic management. Patient #10: A new order was received on 6-16-26 for worsening dysphagia. There is not evidence the care plan was updated to include problem statement, goals, and interventions to monitor progress towards outcomes related to aspiration. Patient #13: The patient is documented to have impaired skin integrity with wound care orders. There is no evidence the care plan was updated to include problem statement, goals, and interventions to monitor progress towards outcomes related to impaired skin integrity.”

“Upon patient record review, 5 of 19 (Patient #3, #4, #5, #7, #13) 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 #3: The record indicated to apply lidocaine patch 5% without evidence of a specific location. Patient #4, #7: The record indicated MiraLAX 17gm and is lacking instructions on quantity of liquid required for reconstitution prior to administration. Patient #5: The record indicated a order for MiraLAX 15gm on 5-27-26 as the incorrect dosage and is lacking instructions on quantity of liquid required for reconstitution prior to administration. Patient #13: The record indicated wound orders 5-26-26 wound care to left arm, left ankle, left thigh, right thigh, and right arm. Order is lacking frequency of wound care.”

“Upon patient record review, 6 of 19 (Patient #1, #4, #5, #6, #9, #10 ) 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 #1: Nursing documentation states the patient utilizes a wheelchair for safety and mobility. There is not evidence the hospice plan of care was updated to include this equipment. Patient #4: Nursing documentation states the patient utilizes a Hoyer lift with transfers from bed to chair. There is not evidence the hospice plan of care was updated to include this equipment. Patient #5: Nursing documentation states the patient utilizes a walker for safety and mobility. There is not evidence the hospice plan of care was updated to included this equipment. Patient #6, #9: The RNCM updated the aide plan of care to include the use of side rails. There is not evidence the hospice plan of care was updated to include this equipment. Patient #10: The RNCM indicated on the aide assignment floor mat to be in place for patient safety. There is not evidence the hospice plan of care was updated to include this equipment.”

“Upon patient record review, 6 of 19 (Patient #1, #4, #8, #9, #10, #11 ) 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 #1: The aide plan of care was incomplete. There is no evidence the aide care plan provided the available DME in the home to be utilized by the aide during direct patient cares. Patient #4: Documentation was present in the 7-14-26 IDG summary stating patient with continued functional decline, no longer ambulatory and requires use of Hoyer lift for transfers from bed to chair. There was not evidence the aide plan of care was updated to include the Hoyer lift for transfers. Patient #8: Documentation was present in the 8-12-26 IDG summary the patient is a fall risk, ambulates with minimal assistance and transfers with moderate assistance. Aide care plan indicates patient is a fall risk but does not indicate how the patient transfers or type of mobility assistance the patient requires. Patient #9: The nursing documentation indicates wound orders initiated on 7-10-26 the patient has a wound with adhesive wound dressing in place. There is not evidence the aide care plan was updated to include the location of the wound or to notify the RNCM if the adhesive wound dressing is soiled or becomes wet or dislodged during cares. The aide plan of care indicates a shower and bed bath to be completed at every visit without specific instruction on what day to perform each bathing task. Aide documented both bathing types were provided at each visit. The aide care plan indicates the aide to provide a shower but may provide bed bath if the patient is too weak. This is outside of the scope for an aide to perform an assessment to determine the bathing type. Patient #10: An order for thicket was received on 6-16-26. The current aide care plan included the task to encourage fluids at every visit. The aide plan of care was not updated to include aspiration precautions. Patient #11: The aide care plan instructed the aide to provide both assist bath-chair and shower 2 times a week. There is no evidence the aide care plan was updated to identify a bathing type for this patient. Documentation by the aide indicates both a shower and assist chair bath was provided at each visit.”