Altus Hospice

“Upon patient record review, 2 of 19 (Patient #6,#8) 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 6:The medication profile contains entries of lidocaine patch 5% for pain, 2 patch daily and rectal enema 1 unit PRN for constipation. There is no evidence that the medication profile includes the location for placement of the lidocaine patch or the type and amount of rectal enema to be administered. Patient 8:The medication profile includes entries for MiraLAX 1 scoop at bedtime and Acetaminophen 500 mg q 6 hours po as needed, Acetaminophen rectal suppository 650 mg q 4 hours as needed and Norco 5/325mg po q 8 hours as needed. There is no evidence that the entries include the type and amount of diluent for MiraLAX administration or instructions not to exceed 4000 mg of acetaminophen daily.”

“Upon patient record review, 1 of 19 (Patient #6) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 6: There is no evidence in the medical record that a bereavement assessment was completed within 5 days.”

“Upon patient record review, 3 of 19 (Patient #1#4,#8) 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 1:The medical record contains nursing documentation of the patient requiring intermittent suction as needed for secretions. There is no evidence that the plan of care contains problems, goals and interventions for management of secretions and use of intermittent suction. Patient 4:The medical record contains nursing documentation of the patient requiring oxygen 2-4 liters per minute via nasal cannula as needed for shortness of breath. There is no evidence that the plan of care contains problems, goals and interventions related to the use, management and safety of oxygen. Patient 8:The medical record includes nursing documentation on admission that the patient requires anticoagulation therapy using Eliquis. There is no evidence that the plan of care includes problems, goals and intervention related to the risk of bleeding.”

“Upon patient record review, 3 of 19 (Patient #2,#6,#8) 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:The plan of care includes a wound care order on admission related to right hip stage 2 pressure ulcer that notes to cleanse with wound cleanser, pat dry, apply xeroform to wound bed, cover with 4x4 and dry dressing. There is no evidence that the order includes a frequency for wound care to be completed. Patient 6:The plan of care contains orders for lidocaine patch 5% for pain, 2 patch daily and rectal enema 1 unit PRN for constipation. There is no evidence that the order includes the location for placement of the lidocaine patch or the type and amount of rectal enema to be administered. Patient 8:The plan of care contains orders for MiraLAX 1 scoop at bedtime and Acetaminophen 500 mg q 6 hours po as needed, Acetaminophen rectal suppository 650 mg q 4 hours as needed and Norco 5/325mg po q 8 hours as needed. There is no evidence that the orders include the type and amount of diluent or instructions not to exceed 4000 mg of acetaminophen daily.”

“Upon patient record review, 2 of 19 (Patient #4,#5) 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:The aide plan of care includes the task of shampoo noted as minimal of 1 time per week. There is no evidence of a specific frequency for the task to be completed. Patient 5:The aide plan of care includes the task of assist with transfers and ambulation using a wheelchair if tolerated. There is no evidence of a specific frequency for the task to be completed.”

“Upon client record review, 1 of 19 (Patient #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 6: The medical record contains SN visit documentation on 5/31/24 with patient reporting pain at moderate level of 4 out of 10. The plan of care includes a problem statement for pain with the intervention of collaboration with the facility to ensure that patient has adequate pain relief. There is no evidence that the SN collaborated with the facility staff regarding patient’s pain.”