Acara Hospice

“Upon patient record review, 5 of 19 records reviewed (Patient #1, #3, #5, #6, #7) 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 #1: The medication administration record indicated Morphine 10mg/0.5ml (0.25-1.0 ml) Q1hour prn Pain/SOB. There was no evidence of parameters for this dosing. COS. In addition: Lorazepam was listed on the medication administration record, it was indicated as 0.5mg 1-4 tabs po Q2hours prn anxiety/dyspnea. There was no evidence of parameters for this dosing and or no max dose was listed. i.e. 12mg/24 hours. COS. Patient #3: The medication administration record indicated Morphine 10mg/0.5ml (0.25-1.0 ml) Q1hour prn Pain/SOB. There was no evidence of parameters for this dosing. COS. In addition: Lorazepam was listed on the medication administration record, it was indicated as 0.5mg 1-4 tabs po Q4hours prn anxiety/dyspnea. There was no evidence of parameters for this dosing and or no max dose was listed. i.e. 12mg/24 hours. COS. Patient #5: The medication administration record indicated Oxygen 1-10 lpm continuously; There was no evidence of the route of administration and or no parameters for this liter flow titration. In addition: The MAR indicated Senna S 1 - 4 tabs po as needed for constipation. There was no evidence of parameters for the Senna S dosing. COS. Patient #6: The medication administration record indicated Acetaminophen 650mg Suppository PR Q6hours prn, Tylenol ES 500mg 1-2 tab po Q6hours prn pain/temp, and Acetaminophen 500mg 2 tabs twice a day for pain. There were duplicated orders of each medication and no evidence of a maximum dose to not exceed 4000 mg daily. COS. Patient #7: The medication administration record indicated Oxygen 1-5 lpm. There was no evidence of a route for administration and or parameters. COS. In addition, Acetaminophen was ordered 650mg PR Q4hours prn fever/temp & pain, along with an order for Acetaminophen 500mg po Q8hours for pain, there was no maximum dose to not exceed 4000 mg daily. COS.”

“Upon patient record review, 2 of 19 records reviewed (Patient #2, #5) 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 #2: The record indicated the patients start of care was on 06/29/24. There was no evidence of a bereavement risk assessment at the time of the survey. Patient #5: The record indicated the patients start of care was on 04/26/24. There was no evidence of a bereavement risk assessment being completed within 5 calendar days from the election date of hospice care; it was completed on 5/2/24.”

“Upon patient record review, 1 of 19 record reviewed (Patient #10) 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 #10: The record indicated the patients was placed in respite care. There was no evidence of problems/goals/interventions being specified in the plan of care.”

“Upon patient record review, 5 of 19 records reviewed (Patient #1, #3, #5, #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 medications and treatments. Patient #1: The MD order indicated Morphine 10mg/0.5ml (0.25-1.0 ml) Q1hour prn Pain/SOB. There was no evidence of parameters for this dosing. COS. In addition: Lorazepam was ordered as 0.5mg 1-4 tabs po Q2hours prn anxiety/dyspnea. There was no evidence of parameters for this dosing and or no max dose was listed. i.e. 12mg/24 hours. COS. Patient #3: The MD order indicated Morphine 10mg/0.5ml (0.25-1.0 ml) Q1hour prn Pain/SOB. There was no evidence of parameters for this dosing. COS. In addition: Lorazepam was ordered as 0.5mg 1-4 tabs po Q4hours prn anxiety/dyspnea. There was no evidence of parameters for this dosing and or no max dose was listed. i.e. 12mg/24 hours. COS. Patient #5: The MD order indicated Oxygen 1-10 lpm continuously; There was no evidence of the route of administration and or no parameters for this liter flow titration. In addition: The MD order for Senna S was written for 1 - 4 tabs po as needed for constipation. There was no evidence of parameters for the Senna S dosing. COS. Patient #6: The MD order was written for Acetaminophen 650mg Suppository PR Q6hours prn, Tylenol ES 500mg 1-2 tab po Q6hours prn pain/temp, and Acetaminophen 500mg 2 tabs twice a day for pain. There were duplicated orders for each of the three orders and no evidence a maximum dose to not exceed 4000 mg daily. COS. Patient #7: The MD order indicated Oxygen 1-5 lpm. There was no evidence of a route for administration and or parameters. COS. In addition, Acetaminophen was ordered 650mg PR Q4hours prn fever/temp & pain, along with an order for Acetaminophen 500mg po Q8hours for pain, there was no maximum dose to not exceed 4000 mg daily. COS.”

“Upon patient record review, 1 of 19 records reviewed (Patient #1) 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 was using a Hoyer lift, this was not on the aide plan of care. COS.”

“Upon patient record review 2 of 19 record reviewed (Patient #1, #3) 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 #1: The hospice aide care plan indicated for the patient to receive oral care and nail care. There was no evidence this was completed by the aide on 8/9/24. The aide did not report these task as not being completed to the RN. Patient #3: The hospice aide care plan indicted for the aide to chart the last BM, change the linens, complete a bed bath, nail and foot care and to shampoo on bath days. There was no evidence of these assigned task being completed on visit date 8/6/24 and no notification to the RN that these were not completed.”