Choice Hospice

“Upon patient record review, 2 of 23 (Patients # 2, 3) 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: Patient’s medication list had the following medications listed twice, a) Aspirin 81 mg PO daily, Atorvastatin 10 mg PO bedtime, CoQ-10 100 mg PO daily, Dulcolax 10 mg rectal suppository daily PRN for constipation, Duloxetine 30 mg, 1 tab PO daily, Furosemide 20 mg, 1 tab PO every other day, Metoprolol Tartrate 25 mg, 1 tab PO nightly, Ondansetron 4 mg, PO every four hours PRN for nausea or vomiting, and Potassium Chloride ER 10 meq’s, 1 tab PO very other day. The facility medication list did not contain the medications, Promethazine 25 mg, 10 tab every four hours for nausea or vomiting, Tylenol Extra Strength 500 mg PO or rectal PRN every four hours for pain Lorazepam 0.5 mg, 1 tab sublingual every two hours PRN for anxiety or SOB, Dulcolax 10 mg rectal PRN daily for constipation, and Hyoscyamine 0.125, 1 tab sublingual every four hours for increased secretions. Patient # 3: Patient’s medication list contained the following medication, Benadryl 25 mg, this medication was not listed on the facility medication list. The patient had orders for Dulcolax 10 mg rectal suppository daily as needed for constipation. This medication was not listed on the facility medication list. The facility medication list contained the medications of Cefuroxime 500 mg, 1 tab twice daily and Esomeprazole Magnesium 40 mg, 1 tab PO daily. These medications where not listed on the hospice’s medication list.”

“Upon patient record review, 22 of 23 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 23) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient # 1, 6, 10, 11, 14, 15, 18: Plan of care contained orders for Nursing PRN 4, SC PRN 2. The orders did not contain a statement of scope. Patient # 2: Plan of care contained orders for Nursing PRN 4, SC PRN 1, MSW PRN 1. The orders did not contain a statement of scope. Patient # 3: Plan of care contained orders for Nursing PRN 8, MSW PRN 1. The orders did not contain a statement of scope. Patient # 4: Plan of care contained orders for Nursing PRN 4, MSW PRN 4, SC PRN 2. The orders did not contain a statement of scope. Patient # 5, 8, 17, 20: Plan of care contained orders for Nursing PRN 4. The orders did not contain a statement of scope. Patient # 7: Plan of care contained orders for Nursing PRN 4, SC PRN 1. The orders did not contain a statement of scope. Patient # 9: Plan of care contained orders for Nursing PRN 6, MSW PRN 1. The orders did not contain a statement of scope. Patient # 12: Plan of care contained orders for Nursing PRN 8, MSW PRN 1, SC PRN 1. The orders did not contain a statement of scope. Patient # 13: Plan of care contained orders for Nursing PRN 7, MSW PRN 1. The orders did not contain a statement of scope. Patient # 16: Plan of care contained orders for Nursing PRN 4, SC PRN 1, MSW PRN 1. The orders did not contain a statement of scope. Patient # 21, 23: Plan of care contained orders for Nursing PRN 4, MSW PRN 1. The orders did not contain a statement of scope. Patient # 22: Plan of care contained orders for Nursing PRN 13, MSW PRN 12. The orders did not contain a statement of scope.”

“Upon patient record review, 4 of 23 (Patients # 1, 2, 3, 4) 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: Patient using adult briefs, wipes, gloves, gauze pads and kerlix. These items where not contained on the plan of care printed 6/1/26. Patient # 2: Patient using adult briefs, wipes, gloves, hospital bed, wheelchair and moisture barrier pads. These items where not contained on the plan of care printed 6/1/26. Patient # 3: Patient using adult briefs, wipes, gloves, wheelchair and moisture barrier pads. These items where not contained on the plan of care printed 6/1/26. Patient # 4: Patient using wipes, gloves, hospital bed, moisture barrier pads, O2 concentrator, Hoyer lift, over bed table, and a wheelchair. These items where not contained on the plan of care printed 6/2/26.”