Choice Hospice

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following, the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 3 (67%) clinical records reviewed revealed the organization did not ensure a medication reconciliation was completed and medications updated to the medication profile. Home Visit 1: The patient’s date of election was 03/27/2024. The last comprehensive assessment was dated 08/19/2024. The Medication Profile dated 08/20/2024 revealed Citrucel 500mg twice daily. During the Home Visit on 08/21/2024 with the hospice aide (Personnel Record 8), the medications in the facility revealed Olanzapine 10mg at bedtime started on 01/18/2024, Fiber-Lax 625mg twice a day at 8am and 4pm started on 06/10/2024, and Ondansetron 4mg every six hours as needed for nausea and vomiting started on 03/27.2024. The medication aide stated that the Citrucel was discontinued on 06/10/2024. Home Visit 2: The patient’s date of election was 02/26/2024. The last comprehensive assessment was dated 08/14/2024. The Medication Profile dated 08/20/2024 revealed Evac-U-Gen (Sennosides) 8.6mg daily, Hydralazine 50mg daily hold for SBP less than 110, SBP less than 60, and pulse less than 60, Lisinopril 10mg daily hold for SBP less than 60, DBP less than 60, pulse less than 60, and Lorazepam 0.5mg every four hours while awake and hold for sedation. During the Home Visit on 08/21/2024 with the medical social worker (MSW) (Personnel Record 6),the medications in the facility revealed Evac-U-Gen (Sennosides) 8.6mg every other day started on 08/30/2023, Hydralazine 50mg twice a day hold for SBP less than 180, HR less than 60 started on 05/12/2024, Lisinopril 40mg daily hold for SBP less than 180, HR less than 60, Lorazepam 0.5mg half a tablet daily started on 05/30/2024, Lorazepam 0.5mg at bedtime started on 05/29/2024, and Albuterol Sulfate HFA 180 (90 base) mcg/ACT one puff inhaled every six hours as needed for shortness of breath started on 02/14/2024. During a joint record review and interview on 08/21/2024, the Administrator/Clinical Director confirmed that there was no documented evidence the medications were reconciled at the time of each comprehensive assessment and updated to the drug profile.”

“It is required that the hospice maintains, documents, and provides hospice volunteer orientation and training that is consistent with hospice industry standards; it includes the volunteer’s duties and responsibilities, the person to whom they report, the person to contact if they need assistance and instruction; hospice goals, services, and philosophy; confidentiality and protection of the patient’s and family’s rights; family dynamics and psychological issues surrounding terminal illness, death, and bereavement; procedures to be followed in an emergency and/or following the death of a patient; and guidance specific to individual responsibilities. This standard was not met as evidenced by interview and personnel record review. In 1 of 1 (100%) personnel records of volunteers reviewed revealed that the agency did not ensure that the agency maintained, documented, and provided hospice volunteer orientation and training consistent with the hospice industry standards. Personnel Record 11: The volunteer’s date of hire was 01/17/2024. The record lacked evidence of hospice volunteer orientation and training consistent with hospice industry standards. During a joint record review and interview on 08/21/2024, the Administrator/Clinical Director confirmed that the records did not include evidence of the volunteer receiving the volunteer orientation.”