Amen Hospice Huntsville

“Upon patient record review, 3 of 14 (Patient #2, #4, #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 #2: Upon review of the medication profile the Ciclopirox topical cream did not include specific instructions on where the medication was to be applied. Patient #4: Upon review of the medication profile included Dulcolax 5mg to be given once daily as needed for constipation. There was not evidence of specific instructions to indicate under what circumstance to administer this medication. Patient #8: Upon review of the medication profile included MiraLAX 17gm powder. There was not evidence that indicated the specific quantity of liquid for reconstitution prior to administration.”

“Upon patient record review, 2 of 14 (Patient #5, #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 #5: The medication profile indicates the patient is on oral diabetic medication. There was no evidence of a problem statement with goals, interventions, and progress toward outcomes related to risks associated with the management of diabetes. Patient #8: The patient was admitted on 9-1-25 and passed on 9-4-25 and was deemed imminent at the time of admission. There was no evidence a imminent death care plan was initiated.”

“Upon patient record review, 5 of 14 (Patient #2, #4, #6, #8, #9) 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 order on 2-11-25 indicates to apply ciclopirox 0.77% topically twice daily. The order does not identify the area(s) for application. Patient #4: The order on 5-28-26 indicates to administer Dulcolax 5mg daily as needed for constipation. There was not evidence the order indicated the circumstance on when to administer. And, an order for on 3-24-26 to administer Ibuprofen 200mg, 1-2 tablets as needed for pain. There was not evidence of clinical parameters to determine the appropriate dose to administer based on the patients reported level of pain. Patient #6: A wound order received on 7-22-26 with instructions to apply protective form bandage to deep tissue injury to left heel once weekly and as needed if soiled or removed. There is no evidence who is responsible for completing the cares - patient resides in a assisted living facility. Patient #8: The order on 9-1-25 for MiraLAX 17 grams failed to indicated the specific quantity of liquid required for reconstitution prior to administration. Patient #9: Documentation was present in the clinical note the patient had an colostomy with minimal output noted for 7 days prior to admission on 8-25-25. The nursing notes on 8-26-25 indicates a colostomy is in place and the nurse is to provide cares to the ostomy site each visit. There was no evidence of an order for the colostomy care.”

“Upon client record review, 1 of 14 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: An order was received on 6-2-26 for wound care to great L toe with directions to clean with wound cleaner, dry and apply bandage every nursing visit and when soiled. Nursing Documentation is present on 8-4-26 stated skin is intact and L toe is open to air. There is no evidence an order was received to update the plan of care to reflect the discontinuation of the current wound treatment or that current POC was followed.”

“Upon patient record review, 2 of 14 (Patient #2, #3) 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 #2: The patient has adhesive bandages to bilateral hips in place for prevention of skin breakdown. There is no evidence the hospice aide care plan was updated to reflect location of bandages and lacking instructions if bandages become wet or dislodged during aide cares to notify the RNCM. Patient #3: The patient required the use of a walker and wheelchair for safety with mobility. There is no evidence the aide care plan was updated to include this DME.”